Maryland’s Statewide Needs Assessment · 20/09/2010 · community forums and focus groups of key...

Maryland’s Statewide Needs Assessment

September 20, 2010

Table of Contents

Introduction Page 1 Needs Assessment Process Page 1 Needs Assessment Findings Page 9 Communities At Risk Page 12 Capacity for Providing Substance Abuse Treatment Page 21 Results and Next Steps Page 22 List of Appendices Page 26

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Maryland Home Visiting Needs Assessment – Supplemental Information Request #1- September 20, 2010

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Affordable Care Act Maternal, Infant and Early Childhood Home Visiting Program Response to Supplemental Information Request #1 for the Submission Maryland

Statewide Home Visiting Needs Assessment September 20, 2010

I. INTRODUCTION

Maryland is home to 5.6 million residents including 380,606 children ages 0-4, 370,292 children ages 5-9, and 1.2 million women of childbearing age. Maryland is a racially and ethnically diverse State with 42% of its population representing racial and ethnic population groups in 2008. There were more than 77,000 births in 2008, the majority (54%) of them to racial/ethnic minority mothers. Although one of the wealthiest States in the nation, Maryland’s ranking on a number of key health related indicators vary from best (e.g., income and education) to among the worse (e.g., infant mortality and related risk factors). There are significant pockets of poverty in the State, namely in Baltimore City, on the Eastern Shore and in Western Maryland. Health disparities continue as a widespread problem across Maryland (e.g., the African American infant mortality rate is two to three times the White rate), exacting a significant toll on the State’s overall health. The disparity gap reflects not only a lack of access to care for some Marylanders, but other factors including the social determinants of health.

Last school year, one in three Maryland kindergarteners entered school unhealthy and unprepared to learn. Early childhood stakeholders in Maryland have a history of commitment to the process of creating an early childhood comprehensive system that delivers integrated, family focused early childhood services including home visiting programs in areas of greatest need throughout the State. Maryland addresses early childhood systems building through unified partnerships and planning efforts.

At the State level, there is a Maryland Children’ Cabinet designated by the Governor to coordinate Maryland’s child and family service delivery system with emphasis placed on the provision of prevention, early intervention and community based services for children and families. The Cabinet is comprised of the Secretaries of major child and family serving agencies including Health and Mental Hygiene (DHMH), Education (MSDE), Humans Resources (DHR), Juvenile Services (DJS) and Disabilities (DOC). The Governor’s Office for Children (GOC) provides administrative support to the Cabinet and oversees implementation of the State’s Children’s Plan. The GOC’s Executive Director chairs the Cabinet. The Children’s Cabinet and the GOC are overseeing the development and implementation of the ACA funded home visiting program. Governor Martin O’Malley has designated the Department of Health and Mental Hygiene, Center for Maternal and Child Health as applicant/administering agency on behalf of the Children's Cabinet. The Children's Cabinet will serve as an advisory body for selecting high risk communities in which evidence-based models in these communities will be funded.


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Other collaborative efforts include a State Early Childhood Advisory Council (ECAC) that oversees implementation of a State Plan to improve school readiness. The State’s ECCS Plan has been integrated into the Council’s State Plan for Early Childhood. This Plan has identified mental health, maternal substance abuse, health disparities and perinatal health issues as priority areas of need.

Ensuring that children are born healthy and maintain good physical and mental

health is a critical first step in all early childhood efforts. However, until recently, the important role of health during the early childhood period was sometimes overlooked and under-funded. In August 2009, Governor O’Malley identified the need to improve the health of Maryland’s infants as one of his top 15 strategic policy goals under an initiative termed the Governor’s Delivery Unit (GDU) Plan. State funds appropriated under a Babies Born Healthy Initiative are being used to implement a life course approach to improving the health of women and infants prior to, during and following pregnancy. New home visiting funds combined with existing services will help to strengthen this approach.

Under the new ACA Home Visiting Initiative, Maryland will continue to build

upon previous programs as well as continue to blend new strategies from the Home Visiting State Plan as it is developed. As described below, Maryland plans to mobilize new and existing partners to implement strategic planning and collaborative processes using new home visiting funds to promote healthy child/family development and school readiness Statewide. The sections below describe Maryland’s approach to conducting the preliminary home visiting needs assessment to identify communities at risk through analysis of data and assessment of capacity.

II. MARYLAND NEEDS ASSESSMENT PROCESS

For the Needs Assessment, Maryland has looked at 15 indicators that put children and families at-risk including: infant mortality, premature birth, unemployment, poverty, and crime rates. Maryland collected information about current home visiting programs and substance abuse services throughout the State. Maryland has used a systematic approach for looking at data and capacity in our State and communities. The Center for Maternal and Child Health along with partners will use the information gathered to support the highest risk communities and guide them in their decisions on the types of resources needed for their communities. In addition, the information gathered will inform the State on policy and further the coordination of a home visitation system of care in Maryland. Steps in the needs assessment process have included:

1. Reviewing data and findings from related needs assessments as required in the

guidance; 2. Collecting Statewide and community level data to assist in determining and

prioritizing “communities at risk;” 3. Conducting surveys to assess capacity; and


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4. Engaging stakeholders through key informant meetings, data sharing and an August 2010 Stakeholder Meeting.

Ongoing assessment of community needs and strengths is crucial to developing a useful and well-considered strategic plan. To this end, Local Management Boards (whose job is to plan, implement, and monitor child and family services) (LMBs) in Maryland jurisdictions, initiated a comprehensive assessment process beginning in May 2009 utilizing multiple components, including: analysis of available secondary data, community forums and focus groups of key informants, service provider surveys, and community surveys. In addition to providing the LMB and its partners with a demographic profile of the community, this process yielded useful community feedback related to the current delivery of services as well as information about critical gaps in services to families and children, levels of developmental assets among children and youth, patterns of risk-taking behavior among adolescents, and suggestions for improving results for our county’s children. Although data was not available for use in each county identified at risk, Maryland was able to compare findings from the Home visiting Needs Assessment and the LMB needs assessment in the following counties: Dorchester County, Washington County and Wicomico County to ensure a comprehensive and detailed look into specific needs. 1. Reviewing Findings from Related Needs Assessment: Title V, Head Start, and CAPTA II

Maryland has a rich history of collaboration and partnerships. Through the home visiting needs assessment, we have made additional inroads in data sharing and reporting on our most vulnerable populations. Below is a brief summary of the three needs assessments/annual reports from our partnering organizations. The required letters of support from each of the partnering agencies are contained in Appendix C. Title V Needs Assessment

CMCH is responsible for preparing the MCH Block grant needs assessment and data gathered for Title V significantly supported the home visiting needs assessment. The Leadership Team for the Title V Needs Assessment also coordinated the home visiting needs assessment. Statewide data from the Title V needs assessment was used to measure several of the indicators in the Statewide Data Report (Appendix A).

Maryland identified 8 MCH priorities for the 2010 Title V needs assessment,

including one focused on improving access to home visiting services for at risk children and families: Promote early and middle childhood health, healthy child development and parent-child connectedness by increasing access to evidence based home visiting programs.

Similar to findings from the 2005 needs assessment, for the 2010 needs assessment, Title V heard about the need to support and strengthen families to assure that children remain healthy and thrive. This need for support is cross-cutting and required for


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all Maryland families, but especially needed for socio-economically disadvantaged families. The Title V Program also recognized that families with young children are especially vulnerable and in need of services to enhance their ability to address their health needs, to meet their developmental needs, and to promote school readiness.

Many Maryland families were anecdotally described as "in crisis or in peril."

Maryland heard that families are disconnected; parents are stressed and overwhelmed with the process of parenting as well as accomplishing the tasks of daily living; parents are placing demands on their children to be "successful;" children are being abused and neglected; and parental substance use is a growing problem. The current recession has led to higher unemployment and many parents are struggling to make ends meet on a daily, weekly or monthly basis. Additional family support is needed.

Family support can take many forms including parenting classes; affordable quality child care; mental health counseling programs; and substance abuse treatment programs. Over the next five years, the Title V Program will promote healthy children by improving access to home visiting programs in areas of greatest risk. Evidence based home visiting programs are a primary prevention strategy for poor birth and child health outcomes, reducing child abuse and neglect prevention, and improving family/parent functioning.

A new State performance measure has been developed to focus on the number of children served in evidence based home visiting programs in Maryland. This is a developmental performance measure. As the State completes its required State Home Visiting Plan, then another more meaningful performance measure may be identified. Head Start Needs Assessment

In Maryland, approximately $78 million in federal grant funds support 19 grantees and 24 delegate agencies. This reflects the addition of one new Early Head Start grantee during recent expansion initiatives. These programs operate over 250 program sites Statewide. In addition, the Collaboration Office is funded through a federal Head Start grant. Direct services are provided through 15 Early Head Start programs, which serve pregnant women and children under three years old; and 28 Head Start programs, which serve child aged three to 5 years old. Four agencies have both Head Start and Early Head Start programs and three grantees do not provide direct services, but have delegate agencies that provide services. Head Start Programs serve children in all 24 counties within the State. However, Early Head Start is only found in 10 counties and Baltimore City.

CMCH partners with the Maryland State Department of Education (MSDE)’s

Division of Early Childhood Development (DECD) on many issues including child care, and with the DECD Head Start Collaboration Office on many projects including the Early Childhood Advisory Council. The Head Start Collaboration Office provided CMCH with a copy of it most recent needs assessment/strategic plan for 2009-2010. The needs assessment report identified twenty improvement objectives which are reflected in the State Strategic Plan. These objectives include increasing access to oral health and


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mental health services for Early Head Start and Head Start children, and promoting improved parent and staff knowledge on health services. The Head Start/Early Head Start needs assessment report/strategic plan contained little data of use to the home visiting needs assessment, however, data from the annual Program Information Report for 2007-2008 (most recent data available) proved to be very useful. Data from this Report was used to the complete the Statewide Reporting Matrix in Appendix A.

Annual data from the Program Information Report from 2007-8 indicate that just

over 12,000 low-income children and over 180 pregnant women received services from Head Start and Early Head Start programs in Maryland. Nearly 6,000 children were enrolled in full-day, five-days per week Head Start programs in Maryland; while an additional 3,848 children were in part-day programs. Other children were served in home-based settings and nearly all programs were operating at their full capacity. Most of the children served were 3 and 4 year olds, and the majority of the families were determined to be eligible based upon their income being below 100% of the federal poverty level. Nearly two-thirds of the families served in Head Start programs in Maryland were African American.

CAPTA II Needs Assessment

The Department of Human Resources (DHR) has provided with child abuse and neglect data that included counts of indicated and unsubstantiated child abuse and neglect investigations by census tract. Maryland does not use the term substantiated, but rather uses indicated (meaning they can prove there has been abuse and neglect). We are also using unsubstantiated (meaning indications of occurrence but no proof) data to look at the most detail possible. Although the CAPTA II data on the Family Support Index has not been received yet, we used the Community-Based Child Abuse Prevention (CBCAP) annual report submitted to the Administration on Children, Youth and Families. This report was compiled by the designated agency to deliver services, the Maryland Family Network.

DHR is Maryland’s single State agency for administering the Child Abuse Prevention and Treatment Act (CAPTA). In Maryland, CAPTA program funds are provided to the Maryland Family Network to support direct services for CBCAP. These child abuse prevention programs are currently supported through these funds. The CBCAP annual report is summarized and a complete list of the service delivery programs is provided in Appendix J. CMCH has a long-standing relationship with the Maryland Family Network (MFN), the State’s designated CAPTA Title II agency. MFN currently provides support to the Home Visiting Consortium convened by the Maryland State Department of Education (MSDE). MFN has also provided CMCH with their 0-3 Business Plan outlining needs and gaps in service coordination.

The process for identifying unmet needs in communities involves collecting data and community needs assessments from the partners in 23 Maryland communities and CBCAP funds are awarded based in part on the local determination of needs. These


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Statements of need are incorporated into contracts with Family Support Center sponsoring agencies.

With support from the State of Maryland Office on Planning, Maryland Family Network developed a Family Support Index to help determine the need for a family support program within a specific jurisdiction of Maryland. The Family Support Index (FSI) is a weighted composite of the following measures for each Maryland census tract: ratio of births to never married females 15-24 years of age; percent of children 0-5 years of age below the poverty level; median household income; percent of households with public assistance income; and percent of civilian population 16-19 years old not in school and not a high school graduate. These measures are considered to be high risk factors that correlate to child abuse and neglect, and long-term welfare dependency. CMCH has requested, but not yet received, a copy of the FSI, methodology and findings.

2. Identifying At Risk Communities

In addition to relying on existing data and assessments to identify at risk communities, Maryland sought input with State and local stakeholders and came up with 15 indicators of risk. At risk communities were defined using the methodology described below. 3. Conducting Surveys to Determine Current Home Visiting Capacity

Several surveys were completed to ascertain current home visiting capacity in Maryland. This is still a work in progress for some areas of the State and a completed capacity assessment will be submitted with SIR #2. First, State level program administrators of known federal or State funded “evidence based” home visiting programs in Maryland were surveyed. These programs included: Parents as Teachers, Nurse Family Partnership, local health departments, Healthy Families Maryland and Early Head Start. The following questions were asked to assess capacity as identified in the guidance: What county (ies) does your program serve? What home visiting model or approach is used? Name the specific service(s) you provide. List the intended recipients of the service (e.g., pregnant women, infants). What are the targeted goals/outcomes of the intervention (e.g., child maltreatment reduction, maternal and child health, early literacy, reduction of domestic violence)? What are the demographic characteristics of individuals or families served? How is the demographic data collected (e.g., intake sheet, questionnaire done by staff, self report…) What is the number of individuals or families served per month? What is the geographic area served (e.g., entire county, certain neighborhoods, or zip codes)? Maryland has 15 Early Head Start Programs, 14 Healthy Families Programs, 2 Parents as Teachers Programs and one Nurse Family Partnership. St. Mary’s County is


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the only county in our State that does not currently have a home visiting program. Through out looking at the evidence based programs in our State we found the following:

Although some programs only serve infants, or pregnant mothers, or children 0-3, there was overlap in the programs so that Mothers and children up to age 5 may be served in each community.

In most cases, funds come from federal and State dollars. Demographics could vary greatly by community, but all served low income, low

education and young moms.

A detailed summary of each of the four evidence based programs can be found in Appendix E. Second, local health departments were surveyed to determine their home visiting capacity. Seventeen of the 24 Maryland jurisdictions replied to the survey. Several of the local health departments have multiple programs for families and children including programs for children with special health care needs and programs for substance abusing Moms. A detailed summary of the results can be found in Appendix F.

Finally, a survey of all Maryland home visiting programs was conducted in August. Maryland currently has no mechanism in place to identify the quality of home visiting programs offered in the State. Each evidence based program responds to its federal funder and all local health departments report to CMCH. The purpose of the survey was to broadly reach home visiting programs Statewide and gather further detail about the programs offered. This survey was the first attempt to gather information that was wide enough in scope to help inform the needs assessment and develop a plan to track all home visiting programs Statewide. Eighty-eight respondents from State, federal and local agencies provided information on demographics, program capacity, funding and program evaluation. The questions asked were to gather detail on types of programs, zip codes served and numbers of people served in each program. Some of the findings included:

Home visits average 1-2 hours in length and occur weekly to monthly. The duration of stay in a program ranged from 6 months to 3 years. Some programs, most of which were associated with the school system, lasted

from 5 to 13 years (following the student through the system). Home visiting services normally ended due to aging out of the program, end of a

pregnancy, entering school, volunteering to leave the program, or moving out of the jurisdiction.

Monthly client capacity ranged between approximately 10-100 clients per program.

Annual client capacity ranged between approximately 20-300 clients per year. Those that surpassed this range were usually associated with a school system.

Most programs conducted evaluations at the end of the year, or FY. Most programs used a specific program model (i.e., PAT, etc.). Those that did not

seemed to be connected to a Head Start program.


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During State Plan development, this information will be asked again and combined with the evidence based capacity charts to further determine gaps in service and needs in our identified at risk communities. The results were used to complete under section III below. 4. Engaging Stakeholders

Following passage of the new federal law, CMCH immediately began receiving inquiries from various stakeholders about the new federal funds and the process for acquiring them. CMCH and GOC let stakeholders know that a meeting was being planned for early August and that a web site would soon be developed to keep stakeholders abreast of activities. CMCH and GOC hosted the Home Visiting Stakeholder Meeting on August 9, 2010 to acquire input to assist with identifying communities at risk and determining current capacity. Background meeting materials including the agenda, meeting summary and evaluation and stakeholder attendees are contained in Appendix G and the presentations and materials can be found on: http://fha.maryland.gov/mch/stakeholders.cfm.

Preliminary data from both the analysis of at risk communities and a survey to

determine home visiting capacity were presented. Speakers included Jill Antonishak, Research Manager, Pew Charitable Trusts, Center on the States. The University of Maryland School of Medicine Maryland Child and Adolescent Innovations Institute facilitated the meeting and provided a meeting summary. Invitees included representatives from Children’s Cabinet agencies, ADAA, MHA, OMHDD, Maryland Family Network (the CAPTA Title II agency), the Maryland Head Start Office, local health officers/designees departments, local management board directors/designees, and currently State-funded home visiting programs. There were a total of 75 attendees (not including MCH, GOC, Innovations Institute staff and/or speakers). All jurisdictions, with the exception of two, Cecil and St. Mary’s counties, were represented.

Based on feedback from the Stakeholder’s meeting, Maryland added three additional indicators to the federally required indicators – WIC and Medicaid participation and school-readiness. Race/ethnicity was another suggested indicator. Attendees also expressed a strong preference for not weighting the indicators. Additionally, stakeholders provided additional information about home visiting programs within their region/community and shared candid thoughts about what is working.

Additionally, feedback was given to remind us going forward to capture data on the needs of undocumented families, data on families who deliver out of county (i.e. high risk pregnancy delivering in DC or Baltimore) and to include consumers in surveying. Finally, stakeholders shared the need to develop a State Plan that is inclusive of:

1. Home visiting programs that are effective with families with various levels of need (i.e. a home visiting system of care)

2. Support, funding, and time needed to develop and implement a sustainable program


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III. MARYLAND HOME VISITING NEEDS ASSESSMENT FINDINGS AND REPORT 1. Findings from the Statewide Data Report

A Statewide data report and a report for each at risk community has been completed using the reporting matrix located in Appendix A. Maryland’s Statewide data serves as the baseline against which indicators for at risk communities are to be compared. A geocoded map of Maryland can be found in Appendix C and provides a visual description of the identified pocket of need throughout our State.

Maryland’s indicators of prenatal, maternal, newborn, and child risk are mostly

lower than the national average. The percentage of women receiving late (initiated in the third trimester) or no prenatal care was 4.2% in Maryland in 2008 compared with 7.1% nationally in 2007. In 2008, Maryland’s prevalence for premature birth (those born less than 37 weeks gestational age) was 11.0% compared with 12.7% nationally in 2007. (Note however that Maryland’s and U.S. rates are not directly comparable because Maryland computes gestational age via the clinical estimate of gestation, whereas the National Vital Statistics System uses the last menstrual period). The Maryland adolescent (15-19 years) birth rate was 32.7 per 1,000 population in 2008 compared with the higher national rate of 42.5 per 1,000 in 2007.

However, in two key indicators of maternal and child health, Maryland’s indicators are elevated above the national average. The percentage of low birth-weight infants (less than 2500 g) was 9.3% in 2008, compared with 8.2% in the U.S. in 2007. Most importantly, the infant mortality rate in Maryland in 2008 was 8.0 per 1,000 live births compared to 6.75% nationally in 2007.

Indicators of poverty in Maryland are lower than national averages. Maryland’s percent of residents living below the poverty level was 8.7% in 2008, compared with 13.2% nationally. However, among needy subpopulations, the Maryland rate of unemployment among families enrolled in Head Start was higher, 15.0% of 2 parent families were both unemployed, and 40.9% of single parent families were unemployed in 2008 through 2009, compared with the national unemployment rate of 9.3% in 2009 among all members of the workforce.

In 2008, Maryland’s crime rate was 41.5 per 1,000 residents which was close to the national rate of 36.7 per 1,000 residents for violent and property crimes.

SAMSHA’s National Survey on Drug Use and Health for 2008 reported that Maryland’s prevalence for various types of substance abuse was roughly similar to national rates. Maryland was reported as having 21.7% of persons age 12 and older having binged on alcohol during the past month compared with 23.3% nationally. Approximately 4.9% of Marylanders reported marijuana use in the past month compared to 6.1% nationally. The rate of nonmedical use of pain relievers was higher in Maryland


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at 3.9% compared to 1.9% in the U.S. The prevalence of illicit drug use excluding marijuana was 3.1% in Maryland and 3.4% nationally. 2. Identification of the Unit Selected as “Community”- Methodology for Identifying Communities At-Risk

Defining “Community.” In Maryland, there is no definition for community that is used across all jurisdictions. There are 23 counties, which vary in size and in composition from rural to suburban. There is also one large city, Baltimore. The goal of the needs assessment was to use the finest geographic granularity available for each metric in order to identify pockets of need. For many metrics, the smallest geographic unit of measurement was the census tract. However, census tracts are not generally useful to people providing community services. Baltimore City had previously defined community statistical areas (CSAs) as aggregates of census tracts to define 55 distinct neighborhoods for the purposes of data analysis and program development. These CSAs are used to define communities within Baltimore City for this assessment. For the remaining 23 jurisdictions, we chose to use ZIP codes as proxies for communities. This unit was selected because we have found that many service providers are comfortable specifying which ZIP codes they provide services to, i.e. using ZIP codes to identify their catchment area. The full chart of communities at risk can be found in Appendix B.

Selection of Indicators. The Affordable Care Act (ACA) specified areas to be measured in order to identify communities with concentrations of:

• Premature birth • Low-birth weight infants • Infant Mortality (including death due to neglect) • Or other indicators of prenatal, maternal, newborn, or child health risk • Poverty • Crime • Domestic Violence • High School Dropout Rate • Substance Abuse • Unemployment • Child Maltreatment

In the process of selecting specific indicators, we strove to find metrics which

would meet three key criteria: 1) the data needed to be available Statewide, i.e. measured in the same way in all 24 jurisdictions, 2) utilize the finest granularity data available (preferably census tract), 3) utilize the most recent data available. We then proceeded to select indicators for each area specified in the ACA legislation. All data were available Statewide, and many were available at the census tract level. For those that weren’t, we attempted to utilize indicators available at the ZIP Code level. Unfortunately there were still a few indicators for which data were only available at the jurisdiction level.

Maryland shared a preliminary analysis of indicators at a Home Visiting Stakeholders meeting and requested feedback on whether additional indicators would be


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useful. Two additional indicators were added as a result of these recommendations. A full description of each indicator, the justification for selection, data source, granularity, rate definition, years covered, and limitations is included in Appendix B1.

Defining Elevated Risk. Elevated risk was defined, for the purpose of this needs assessment, as a unit (census tract, ZIP code, or jurisdiction) with a rate that was substantially greater than the State average for that indicator. Maryland decided that rates that were greater than one standard deviation from the mean would be considered elevated.

The process for computing this elevated risk follows: For each indicator, once a rate or percentage was computed for each unit (census tract, ZIP code, or jurisdiction) the average rate was computed based on all the units. (Note that this average may differ slightly from rates computed at the unit of the entire State because some data is lost due to geocoding errors when census tract or ZIP code units are used.) The standard deviation, based on all units, was also computed. The Z Score for each unit was then computed, and all units that had Z Scores ≥ 1 were mapped using ArcGIS. For elevated risk units at the census tract level, CSAs (Baltimore City) and ZIP codes (other jurisdictions) were overlaid on the map. If a CSA or ZIP code contained at least one elevated census tract, then the CSA or ZIP code was marked as being at elevated risk. For elevated risk units at the ZIP code level, CSAs were overlaid in Baltimore City and the same process was followed to identify neighborhoods at elevated risk. For elevated risk units at the jurisdiction level, all ZIP codes or CSAs in that jurisdiction were marked as being at elevated risk.

Computing an Elevated Risk Index. Once the above described process was performed for all indicators, the elevated CSAs and ZIP codes for each indicator were exported from ArcGIS to a spreadsheet. Each unit was assigned a 1 for an elevated indicator and a 0 for indicators that were not elevated. Then the total number of elevated indicators for each CSA and ZIP code were summed. This total elevated risk index was used to rank the CSAs and ZIP codes.

Defining Communities At-Risk. Although a community with any elevated metrics indicates need in some areas, it was decided that we would focus on those communities in greatest need. We decided to define communities at-risk as those with 10 or more elevated indicators. This resulted in a total of 46 communities at-risk, representing 6 jurisdictions (Baltimore City, Dorchester County, Washington County, Wicomico County, Prince George’s County, and Somerset County).

3. Findings from Data Report – “At Risk Communities in Maryland”

Maryland’s ZIP code/CSA analysis as discussed above identified 368 potential communities at risk (having at least one elevated indicator). Using the process described above, Maryland identified 46 communities with higher than average concentrations of: premature, low-birth-weight, late or no prenatal care, teen birth and infant mortality rates; poverty; crime; domestic violence; high-school drop-outs; low school readiness rates; substance abuse treatment; unemployment; WIC and Medicaid participation; and/or


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child maltreatment. Communities at-risk were defined as those with 10 or more elevated indicators out of the 15 described above. This resulted in a total of 46 communities at-risk, representing six jurisdictions: Baltimore City, Dorchester County, Washington County, Wicomico County, Prince George’s County, and Somerset County as summarized in Appendix B. Baltimore City

Baltimore City is the State’s fourth largest jurisdiction with a total population of 637,418 in 2009 including 45,379 young children ages 0-4 and 149,266 women of childbearing age. By race, the majority of the population is Black (65.5%), followed by Whites (32.0%) and Asians (2.1%). Hispanics represent 2.7% of the population. The City has some of the highest poverty, infant mortality, and unemployment rates in the State. Data from the U. S. Census Bureau’s American Community Survey for 2006-2008 estimates that 20% of individuals lived below the poverty level including 16% of all families, 27% of related children under age 18, and 27% of families with a female headed householder. In 2009, the City’s infant mortality rate of 13.5 per 1,000 live births was 87.5% higher than the State rate of 7.2 per 1,000 live births.

In the recently published County Health Rankings Report released by the University of Wisconsin Public Health Institute in collaboration with the Robert Wood Johnson Foundation, Baltimore City ranked 24th (out of 24) as the jurisdiction with the worst health outcomes and health factors in the State. The County Health Rankings, a collection of 50 reports - one per state - ranks all counties within each state on their overall health. The majority of at-risk communities (39 of the 46) are located in Baltimore City. Seventy one percent of the City’s fifty-five CSAs/neighborhoods have been designated as at-risk. Appendix H contains a map displaying the 39 at risk communities in Baltimore City. The City was the only jurisdiction where communities had a total of 14 elevated indicators out of the 15 described above. There were nine such communities with seven located in the western section of the City, one in the East (Greenmount), and one in the southern section (Cherry Hill). There are ten City neighborhoods that scored 13, nine scoring 12, seven scoring 11 and four scoring 10.

Among the 15 indicators, many neighborhoods in Baltimore City had the highest

rates among the communities at-risk. Three neighborhoods in the city had the highest percentage of preterm births at 25.0%, more than twice the state average at 11.2%. Two neighborhoods had the highest percentage of low birth-weight births at 25.6%, which was over 2.7 times higher than the state average. The communities with the highest levels of families with children living below the poverty level were in Baltimore City. Two communities had 71.8% of their families in poverty. Baltimore had the highest rate of high school dropouts and the lowest level of children entering kindergarten ready to learn. Seven neighborhoods in the city had the highest level of substance abuse treatment at 52.6 per 1,000 women of childbearing age. Baltimore City also had the highest rate of births to adolescents (15-19 years) at 200.0 per 1,000 population which was six times


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higher than the state average of 33.0 per 1,000 population. WIC participation rates were highest in eight neighborhoods in the city at 67.2 per 1,000 total population, compared to 16.8 per 1,000 statewide. Medicaid enrollment rates were also highest in Baltimore with nine communities at 496.4 per 1,000 total population, over 4 times higher than the state average. Substance Abuse Annual Report

In fiscal year 2009, in Baltimore City, females represented 54 percent of program

participants while 46 percent of the participants countywide were male. During fiscal year 2009, approximately 59 percent of all individuals participating in prevention programs were adolescents. Parents or primary care givers represented 22 percent of the distribution in Baltimore City. African Americans accounted for 84 percent of the racial distribution receiving prevention services in Baltimore City while Caucasians comprised 12 percent during fiscal year 2009. Hispanics (2%) and Other (2%) accounted for the remainder of the distribution (4%). The total number of individuals receiving prevention services in Baltimore City was 26,005 in fiscal year 2009.

In a 2008 report from University of Maryland entitled, “Need For Substance

Abuse Treatment In Maryland -- Final Report,” William E. McAuliffe, PhD, created a composite of validated substance abuse indicators. The study used the Substance Need Index (SNI) as the independent variable in a statistical equation to estimate relative gaps in treatment services among the State’s counties. Baltimore City’s SNI score (91) was the highest by far. Treatment needs in Maryland were highest in Baltimore City by a wide margin. Interestingly, the author’s study of indicators in counties nationwide found that Baltimore City’s drug and alcohol problems were among the most severe in the country, especially its drug problems. Baltimore City had the highest rate of treatment admissions, but it nevertheless did not meet the level of admissions to be expected based on its SNI score. Home Visiting Capacity Assessment Baltimore City’s local health department had completed it’s own capacity assessment and the results summarized in Appendix I show provider, target area, service capacity, types of home visitors, eligibility, primary focus, partnerships, current families served, client details including when clients enter service, annual case load and unduplicated numbers, curriculum for home visiting, provision of services based on need, training and licenses for new staff, method of recruitment, discharge criteria and sources of referrals. Up to 1,762 clients are served annually reaching approximately 20% of the population in need.

Assessment of the evidence based home visiting programs, showed Early Head Start serving South East Baltimore City, and Health Families programs located in West Baltimore, Druid Heights, Upton, Mondawmin, Reservoir Hill and parts of Rosemont. An additional 350 children and families are receiving serves through these programs.


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Dorchester County

Dorchester County located on the Eastern Shore is the State’s 21st largest jurisdiction with a total population of 32,043 in 2009 including 1,965 young children ages 0-4 and 5,802 women of childbearing age. By race, the majority of the population is White (70.6%), followed by Blacks (28.2%) and Asians (1.0%). Hispanics represent 2.5% of the population. Data from the U. S. Census Bureau’s American Community Survey for 2006-2008 estimates that 12.7% of individuals lived below the poverty level including 9.4% of all families, 17.9% of related children under age 18, and 35.7% of families with a female headed householder. In 2009, the County’s infant mortality rate of 21.9 per 1,000 live births was 204.2% higher than the State rate of 7.2 per 1,000 live births. In the County Health Rankings Report, Dorchester County ranked 22nd (out of 24) as a jurisdiction with some of the worst health outcomes and health factors in the State.

Dorchester had the highest unemployment rate among the at-risk communities at 10.7%. It also had a community with a substantially elevated infant mortality rate at 31.0 per 1,000 live births, nearly 4 times higher than the state average. Substance Abuse Annual Report

In fiscal year 2009 in Dorchester County, females represented 61 percent of program participants while 39 percent of the participants countywide were male. During fiscal year 2009, approximately one half (47%) of those receiving prevention services in Dorchester County were adolescents. Parents or primary care givers accounted for 41 percent of the distribution. African Americans accounted for 56 percent of the racial distribution receiving prevention services in Dorchester County. Caucasians (39%), Hispanics (3%) and “Other” (2%) comprised the remaining racial distribution during fiscal year 2009. The total number of individuals receiving prevention services in Dorchester County was 3,408 in fiscal year 2009. Dorchester County’s SNI was (42) and the report found it surprising that the results indicated relatively high rates of treatment needs on the Eastern Shore, including Dorchester (34). Like SNI scores, the substance abuse treatment admission rates from privately- and publicly-funded treatment programs were high in Dorchester County (2,158 per 100,000). Home Visiting Capacity Assessment The Dorchester County local health department home visiting programs serve the entire county. The county serves 35-45 families monthly depending upon their service level, including 8 children receiving a home visit every 1 – 3 months, and each woman and/or child getting at least two visits a year. Their current funding allows them a caseload of 20. The LHD uses the Healthy Families program and PAT curriculum. There is an Early Head Start program in the county as well serving an additional 45 families and children 0-3.


15

Washington County

Washington County located in Western Maryland is the State’s 10th largest jurisdiction with a total population of 145,910 in 2009 including 9,298 young children ages 0-4 and 27,023 women of childbearing age. By race, the majority of the population is White (87.9%), followed by Blacks (10.3%) and Asians (1.6%). Hispanics represent 2.9% of the population. Data from the U. S. Census Bureau’s American Community Survey for 2006-2008 estimates that 9.1% of individuals lived below the poverty level including 7.2% of all families, 11.0% of related children under age 18, and 28.8% of families with a female headed householder. In 2009, the County’s infant mortality rate of 7.4 per 1,000 live births was 2.8% higher than the State rate of 7.2 per live births. In the County Health Rankings Report, Washington County ranked 13th (out of 24) on health outcomes and 15th on health factors in the State.

Washington County had the community with the highest rate of protective and peace order filings (a measure of domestic violence) at 115.2 per 10,000 population, compared with 77.8 per 10,000 statewide. The rate of child abuse and neglect investigations was also highest in this community at 11.5 per 1,000 children, over seven times the state average. Substance Abuse Annual Report

In fiscal year 2009, in Washington County, females represented 51 percent of program participants while 49 percent of the participants countywide were male. During fiscal year 2009, about one half (43%) of those receiving prevention services were adolescents. Parents and primary care accounted for 25 percent of individuals receiving prevention services in Washington County. Caucasians (80%) and African Americans (14%) accounted for 94 percent of the racial distribution receiving prevention services. Hispanics (4%) and Asians (2%) represented the remaining 6 percent of the total racial distribution during fiscal year 2009. The total number of individuals receiving prevention services in Washington County was 3,995 in fiscal year 2009. Washington County made the list of largest relative treatment admissions gaps per 100,000 at (18). Most of the western counties had relatively low levels of drug treatment need: only Washington County (13) was above the median. Washington County had a treatment gap of (17). In Western Maryland, Allegany, Fredrick, Garrett, and Washington Counties had treatment gaps.

Home Visiting Capacity Assessment Washington County is home to Healthy Families, Maternal and Child Home Visiting from the LHD, Early Head Start, the Washington County Family Center, the Parent-Child Center and the Judy Center. Each of these programs has traditional home visiting components including Healthy Families and PAT curriculums. It is estimated that 95 children and families are served through these programs.


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Wicomico County

Wicomico County located on the Eastern Shore is the State’s 14th largest jurisdiction with a total population of 94,222 in 2009 including 6,495 young children ages 0-4 and 20,012 women of childbearing age. By race, the majority of the population is White (73.2%), followed by Blacks (24.6%) and Asians (2.0%). Hispanics represent 3.8% of the population. Data from the U. S. Census Bureau’s American Community Survey for 2006-2008 estimates that 12.4% of individuals lived below the poverty level including 7.6% of all families, 15.2% of related children under age 18, and 27.0% of families with a female headed householder. In 2009, the County’s infant mortality rate of 9.1 per 1,000 live births was 26.4% higher than the State rate of 7.2 per 1,000 live births. In the County Health Rankings Report, Wicomico County ranked 19th on health outcomes and 17th on health factors in the State. Wicomico had the community with the highest crime rate among the communities at-risk at 10,730.7 offenses reported per 100,000 population.

Substance Abuse Annual Report

In fiscal year 2009, in Wicomico County, females represented 52 percent of program participants while 48 percent of the participants countywide were male. Parents (11%) and preschoolers (89%) participating in Wicomico County’s preschool program accounted for approximately one third of the individuals receiving prevention services in fiscal year 2009. Over one half (57%) of those receiving prevention services were adolescents. African Americans accounted for 52 percent receiving prevention services while Caucasians comprised 45 percent of the racial distribution. Hispanics (2%) accounted for the remaining distribution. The total number of individuals receiving prevention services in Wicomico County was 1,888 in fiscal year 2009. Wicomico SNI was (26). Perhaps Report results indicated relatively high rates of treatment needs on the Eastern Shore, including Wicomico (26). The highest total substance abuse treatment admission rates per 100,000 residents were in several counties including Wicomico (2,184). Home Visiting Capacity Assessment

The LHD in Wicomico County serves 40 families per month and targets low income (Medicaid or Medicaid eligible) women under age 25 who receive a positive score upon full assessment that indicates that they are at risk for child abuse/neglect. The focus of their prevention services aim to prevent child abuse and neglect, to assure children enter school ready to learn, parents complete GED and have employment and/or further education, promote positive parenting skills, assure children have a medical home and are current with well baby visits and immunizations. Two additional Healthy Families programs are also offered in Wicomico County and they estimate an additional 30 families and children are served annually.


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Prince George’s County

Prince George’s County, a suburban jurisdiction bordering the District of Columbia, is the State’s second largest jurisdiction with a total population of 834,560 in 2009 including 60,333 young children ages 0-4 and 183,750 women of childbearing age. By race, the majority of the population is Black (66.7%), followed by Whites (28.4%) and Asians (4.3%). Hispanics represent 13.5% of the population. Data from the U. S. Census Bureau’s American Community Survey for 2006-2008 estimates that 7.4% of individuals lived below the poverty level including 4.7% of all families, 8.7% of related children under age 18, and 10.2% of families with a female headed householder. In 2009, the County’s infant mortality rate of 8.7 per 1,000 live births was 20.8% higher than the State rate of 7.2 per 1,000 live births. In County Health Rankings Report, Prince George’s County ranked 17th (out of 24) on health outcomes and 14th on health factors in the State.

Prince George’s had two communities that held the highest infant mortality rate, 38.0 per 1,000 live births, among the communities at-risk, which was nearly 5 times the state average. The highest rate of women receiving late or no prenatal care occurred in two communities in Prince George’s County at 22.1% of births. This was over 5 times higher than the statewide average. Substance Abuse Annual Report

In fiscal year 2009, in Prince George’s County, females represented 65 percent of program participants while 35 percent of the participants countywide were male. During fiscal year 2009, adolescents accounted for 58 percent of those individuals receiving prevention services. African Americans accounted for 62 percent of the racial distribution in Prince George’s County. Caucasians (24%) and Hispanics (14%) accounted for the remainder of the distribution for fiscal year 2009. The total number of individuals receiving prevention services in Prince George’s County was 4,460 in fiscal year 2009. The ATOD Center at Bowie State University served 3,387 individuals in fiscal year 2009. Prince George’s County’s SNI of 15 was lower than some observers expected, but its low score mainly reflected low alcohol indicators. Prince George’s County was among the seven counties with the largest treatment gaps. The largest relative treatment admissions gaps per 100,000 were in several counties including Prince George’s County (493). However, the lowest primary alcohol treatment admission rate was in Prince George’s County (217.9 per 100,000). Home Visiting Capacity Assessment

Prince George’s County LHD provides: nursing home visits to high-risk pregnant women to assure adequate pregnancy follow-up for prenatal care, WIC etc. as well as teaching and support about pregnancy; assessment and early intervention at the birth hospital bedside; follow-up inter-conceptual and infant nursing home visits to provide parenting support and education to assess infant health and safety in the home and to assure connection to needed services; visits to at-risk pregnant women, postpartum/interconception women and at-risk infants to age 2 who live in the county.


18

The home visits average 200 per month. The county also has two Even Start programs using the PAT curriculum and an Early Head Start program serving over 109 children. Somerset County

Somerset County located on the Eastern Shore is the State’s 23rd largest jurisdiction with a total population of 25,959 in 2009 including 1,314 young children ages 0-4 and 4,898 women of childbearing age. By race, the majority of the population is White (56.6%), followed by Blacks (42.1%) and Asians (0.9%). Hispanics represent 2.7% of the population. Data from the U. S. Census Bureau’s American Community Survey for 2006-2008 estimates that 19.6% of individuals lived below the poverty level including 13.3% of all families, 30.3% of related children under age 18, and 36.1% of families with a female headed householder. In 2009, there were fewer than 5 infant deaths so an infant mortality rate was not computed. In the County Health Rankings Report, Dorchester ranked 23rd (out of 24) as the jurisdiction with second worst health outcomes and health factors in the State. Somerset County had one community with ten elevated indicators. None of these indicators was among the highest rates of the at-risk communities, but all were significantly elevated above the state averages. Substance Abuse Annual Report

In fiscal year 2009, in Somerset County, females represented 53 percent of program participants while 47 percent of the participants countywide were male. During fiscal year 2009, approximately 67 percent of individuals participating in prevention programs were adolescents. The majority of those individuals receiving prevention services in Somerset County were African American (70%). Caucasians (28%) and Hispanics (2%) accounted for the remaining racial distribution. The total number of individuals receiving prevention services through the Somerset County prevention office was 579 in fiscal year 2009. The ATOD Center at the University of Maryland Eastern Shore served 2,643 individuals in fiscal year 2009. The SNI study took into consideration the small population size of the county (24,747). Drug mortality was the only indicator for which there were no cases in the five-year period studied. Somerset County has one of the highest total substance abuse treatment admission rates per 100,000 residents (1,885 per 100,000). Home Visiting Capacity Assessment

Somerset County’s LHD home visits are based on an educational model that includes anticipatory guidance provided by community health nurses and provides linkage to resources and other community services. The goal is to improve maternal health and birth outcomes, reduce infant mortality, and establish a medical home for infants. The health department averages 40 home visits per month to pregnant women and additional 31visits per month to infants and their mothers.


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In Somerset is one of 2 stand-alone PAT programs in our State. 100 families were served in FY ’10 reporting 13-38 year old mothers with a demographic breakdown of: 66% African American, 4% Hispanic, and 30% Caucasian. There is no Early Head Start or Judy Center. 4. Findings from the Quality and Capacity Assessment of Programs/Initiatives for Early Childhood Home Visitation in Identified “At Risk Communities”

Maryland has identified the quality and capacity of existing programs/initiatives for early childhood home visiting in the State, including the number and types of programs and the numbers of individuals and families who are receiving services under such programs or initiatives; the gaps in early childhood home visiting in the State, including descriptions of underserved communities where possible; and the extent to which such programs or initiatives are meeting the needs of eligible families.

Statewide, there is one Nurse Family partnership program in Garrett County, 14

Healthy Families America programs, 15 Early Head Start programs and 2 stand-alone Parents as Teachers programs as described below. Table 1 below also summarizes federal and State supported home visiting models currently used in Maryland by jurisdiction and type. Nurse-Family Partnership: Only one program is operating in Maryland (Garrett County) with funding from the local health department, local management board, and Community Health Resources Commission. NFP serves low-income, first-time mothers with the aim of preventing low birth weight, prematurity, infant mortality, second births to teen mothers, promotion of school readiness and reductions in (long-term) high-school drop-out and juvenile delinquency rates. Healthy Families America: There are 14 State funded programs currently operating in Maryland with administrative/programmatic support provided by MSDE and local child management boards. Services may begin prenatally or at birth and continue for three to five years. Not restricted to first parents; aimed at promoting positive parenting, enhancing child health and development, and preventing child abuse and neglect. Trained professionals with supervision from either nurses or social workers link families with a medical home and ensure homes are safe. Families are selected through a standardized assessment that identifies health and abuse risk factors. Early Head Start: There are 15 programs in Maryland supported with direct federal funding. The program offers a combined program of center-based classes and weekly home visits for low-income families with infants and toddlers (zero to three years old) and pregnant women; linked to Family Support Centers and/or schools. Parents as Teachers programs across the State, serving families from pregnancy through a child’s school entry. Parents learn what to expect at different levels of development to help become their child’s first teacher. The model includes monthly, biweekly or weekly


20

home visits by a parent educator, group meetings, developmental screenings and referrals. There are two stand alone programs in Maryland and 38 blended programs. Home Instruction for Parents of Preschool Youngsters (HIPPY): Evidence supported. Works with parents of children ages three to five. Linked to schools, HIPPY uses home visitors from the local community to work with low-income families in home visits and group social meetings. There are 4 programs in Maryland. Other Programs. .Some local health departments also offer a case management program called Healthy Start, which may include home visits. There are many local models in place as well. For example, there are at least eight local home visiting models operating in Baltimore City, including the federally funded Baltimore City Healthy Start, Inc., in addition to the national models discussed above. Baltimore City Healthy Start, Inc. uses community health workers to identify at-risk women and connect them with health care and other services

Table 1 Federal and State Supported Home Visiting Programs in Maryland by Jurisdiction and Type

Jurisdiction Healthy Families

Early Head Start

HIPPY PAT* NFP Other

Allegany County X X X Anne Arundel Co. X

Baltimore City X

X X Baltimore City Healthy

Start Baltimore County X X X

Calvert County X X X Caroline County X X Carroll County X Cecil County X

Charles County X X Dorchester

County X X

Frederick County X Garrett County X X X X Harford County X Howard County X

Kent County X Montgomery Co. X X Prince George’s

Co. X

Queen Anne’s Co. X X Somerset County X X

Talbot County X X Washington

County X X X

Wicomico County X Worcester County X X X * Note that there are only 2 stand alone PAT programs (Garrett and Somerset Counties as indicated by a red X). All remaining PAT is used as curriculum as part of another home visiting program.


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5. Narrative Description of the State’s Capacity for Providing Substance Abuse Treatment and Counseling Services to Individuals/Families in Need in “At Risk Communities”

What is currently known about the State’s capacity for providing substance abuse treatment and counseling services to individuals and families in need of such treatment or services is described below. The Alcohol and Drug Abuse Administration (ADAA), is charged with providing access to a quality and effective substance abuse prevention, intervention and treatment service system in Maryland.

ADAA periodically assesses the need for substance abuse treatment services in Maryland, most recently, in 2008, in response to legislation passed by the Maryland General Assembly. ADAA was directed to conduct a needs assessment “for prevention, diagnosis, and treatment of drug misuse and alcohol misuse in the State and to “identify the financial and treatment needs of each jurisdiction and of each drug treatment program operated by the State.” The ADAA subsequently contracted with the Center for Substance Abuse Research (CESAR) at the University of Maryland, College Park, to conduct the treatment needs assessment. CESAR subcontracted with Harvard University researchers to complete the study. The results of from this work are used as a preliminary Statement of need for substance abuse treatment and counseling in Maryland for purposes of the home visiting needs assessment.1

The study’s researchers created a Substance Need Index (SNI) as the independent

variable in a statistical equation to estimate relative gaps in treatment services among the State’s counties. The components of the need indexes were mean rates of drug and alcohol mortality, hospital discharges, and arrests. The study used five years of data from 2001 to 2005.

The need index scores were highest for Baltimore City (91, followed by two Eastern Shore Counties, Worcester (55) and Dorchester (42). The authors noted that national studies indicate that Baltimore City’s drug and alcohol problems were among the most severe in the country, especially its drug problems.” Substance abuse treatment needs were lowest in suburban areas surrounding the District of Columbia (e.g., the SNI in Montgomery County was 11), in counties west of Baltimore County (Howard 14, Carroll 18, and Fredrick 18), and in Western Maryland (Garrett County 20).

The researchers also found:

The areas of greatest unmet need were the suburban counties outside of the District of Columbia, Baltimore County and its surrounding counties (Anne Arundel, Harford, and Carroll), Baltimore City, the western counties, and Cecil County.

Among the seven counties with the largest treatment gaps were four (Prince George’s, Montgomery, Howard, and Harford) with SNI scores below the median, but they also had especially low levels of treatment admissions.

1 William E. McAuliffe, et al. Need for Substance Abuse Treatment in Maryland: Final Report, Revised, December 15, 2008. Report prepared for the Maryland Department of Health and Mental Hygiene, Alcohol and Drug Abuse Administration to the Center for Substance Abuse Research at the University of Maryland, College Park under DHMH Agreement Number DHMH-OCPMP 08-9720G.


22

The largest relative treatment admissions gaps per 100,000 were in Allegany County (550), Prince George’s County (493), Baltimore County (434), Howard County (397), Cecil County (259), Montgomery County (254), Harford County (249), Worcester County (160), Fredrick County (120), Baltimore City (116), Anne Arundel County (101), Carroll County (76), Garrett County (43), St. Mary’s County (24) and Washington County (18).

If all of the gaps were completely eliminated so that these counties had treatment admissions rates consistent with estimated need, an additional 13,807 admissions per annum would be required.

Preliminary findings on substance abuse treatment needs by jurisdiction are

summarized above. The next step in the planning process is to convene a meeting with the ADAA as well as local substance abuse agencies to address additional data and capacity needs. This will assist the State in determining the specific needs of our identified at risk communities and further clarify gaps in needs. 6. Narrative Summary of Needs Assessment Results including Discussion of How the State will Address Unmet Needs Because of the needs assessment, Maryland has a clearer understanding of the existing home visiting needs, programs and capacity. In our State:

There are 46 identified communities at risk. Every local health department except St. Mary’s and Harford County provide

home visiting services to mothers and children. Head Start provides services to 1,247 children and families in 15 programs

serving Baltimore City, Baltimore County, Allegany, Anne Arundel, Caroline, Cecil, Talbot, Dorchester, Garrett, Harford, Montgomery, and Washington Counties.

There are two stand alone Parents As Teachers programs, but PAT curriculum can be found in over 50 programs Statewide.

There are 18 counties with Healthy Families programs serving over 757 families.

Now that Maryland has taken a preliminary assessment of programs and home visiting capacity in our State and reviewed the data from the communities identified at risk, there are several next steps needed to develop the State plan. Maryland will begin the self assessment process. We have begun to assess detailed home visiting capacity and we have prioritized the 15 indicators as areas for improvement. In order to most completely address gaps in service and unmet needs, Maryland has taken steps to assure a solid infrastructure and organized supports that should guarantee a wide reach across State agencies and firm foundation on which to build a coordinated system of care for women and children in need of home visiting services. Below is an outline of next steps:


23

1. Hire Staff

Through the initial funding allocation, Maryland is currently in the process of hiring several key staff to support the infrastructure of home visiting in our State. The project leader will be the same person who administers the ECCS grant. This ensures the integrity of the project and keeps the continuity and coordination of activities in early childhood throughout State agencies. The Project Director is responsible for providing coordination of State level efforts through work with other State agencies, supervising project staff while working closely with the epidemiologist, community coordinator, and a research assistant. The Project Director will oversee the development and implementation of a State Plan and assure coordination of activities across agencies.

To continue the infrastructure needed to build a sound program, the additional positions to be filled are as follows:

Epidemiologist: This position will have chief responsibility for collecting and analyzing data on child and family needs, service use and capacity. She/he will work closely with the Program Director and the senior epidemiologist to complete the needs assessment as well as collect and analyze data for the required benchmarking and monitoring of State Plan outcomes. Health Policy Analyst: This position will serve as the policy analyst and staff the Home Visiting Consortium which will move to GOC. This individual will work for the Executive Director of the GOC to coordinate work with the State and local agencies, provide support to the Maryland Children’s Cabinet on home visiting issues, liaison with other State agencies, and work with Innovations Institute on evaluation of the program. Community Development Coordinator: This position will oversee the development and implementation of local-level components of the comprehensive strategic plan for developing, implementing and sustaining infrastructure and programs in the identified at risk communities. Duties will include: outreach and education to community groups in targeted at-risk communities with low capacity, and providing leadership with local agencies, including the establishment of interagency collaborations with other community based, child and family serving public agencies. Program Consultant: A consultant will provide technical expertise in home visiting and early childhood education and will assist in the development and implementation of the State plan. Research Assistant: A research student will be hired to provide staff support to the MCH home visiting needs assessment, strategic planning and policy development; assist epidemiologist in conducting analyses and preparing reports using State data; design and conduct surveys and focus groups, then analyze results, to ascertain various needs of maternal and child health populations in collaboration with staff; participate in policy discussions and development of policy alternatives; and contribute to policy


24

recommendations and intervention strategies for identifying at-risk communities and developing the State Plan for home visiting the maternal and child health population. These positions are currently being filled through the contractual State hiring process. 2. Convene Work Groups to Conduct Local Planning

Maryland will convene four work groups, one in each priority jurisdictions/region: Baltimore City, Western Maryland, Eastern Shore and Prince George’s County. The goal of each work group is to develop a mission and vision for home visiting in their community and work with the State to determine the next steps needed. The four groups will contribute to the State plan process and be an integral part of the decisions made. 3. Develop a State Plan

A State plan will be coordinated and developed over the next several months. This will be accomplished through a number of existing groups including ECAC, and the Home Visiting Consortium annual conference. Because we have gathered detailed information, and we have multiple home visiting models, we will use the current charts and tables to inform our executive group and conduct workgroups to address the mission, vision, gaps, and needs.

Our State needs to ask tough questions. When we begin to convene our workgroups, in order to plan for the sustainability of programs, the following questions will be addressed: a. How will Maryland centralize intake and assessment mechanisms and/or establish criteria that determine how families are assigned to particular program models? b. How will we centralize data systems and collect information on key home visiting indicators and statistics? c. What additional gaps remain in service delivery of home visiting, substance abuse and child abuse prevention? d. How shall we determine a process for program expansion into the State plan? e. What (if any) mechanisms are in place to provide funding, technical assistance, and support to new program sites? Since Baltimore City has demonstrated such great need (39 of the 46 at risk communities identified) we will potentially work to fund a project in the City – the greatest area of need. Baltimore City already has a “Targeted Plan” for infant mortality that sets a strong foundation for receiving the additional funding support to bring it to scale. It is Maryland’s intent to work with the remaining areas to get them ready for funding in subsequent years. 4. Convene an Advisory Group

The needs assessment will be presented to the Children’s Cabinet for final approval and a decision on at risk areas. Our State will hold additional stakeholder


25

meetings to get buy-in and feedback on gaps and needs. We will utilize a smaller group of the original 75 stakeholders to be the Maryland Home Visiting Advisory Group. This group will meet regularly and complete the needed steps of developing the State plan. One of the key elements in coordinating this Advisory Group will be to bring the home visiting indicators and benchmarks that are developed- to other State plans. This will ensure that there is coordination and blending of resources and champions of home visiting throughout other agencies.

5. Request TA from MCHB

When the Advisory Group begins to develop the benchmarks that support the chosen indicators, it is Maryland’s intention to request technical assistance from MCHB. At that time we will request support/TA on development activities in the jurisdictions at risk, but not yet funded (i.e., Prince George’s County, Western Maryland and the Eastern Shore). Maryland’s Next Steps

Maryland will continue to seek information to complete more detailed substance abuse and child abuse capacity assessments. In addition, we will further examine other home visiting capacity data to determine trends and missing information. After this is conducted, we will engage our Advisory Group to assist in determining areas of high need and low capacity across the State. This will give us clear direction on the needs of the communities and drive the course of the State Plan. Maryland plans to position itself to be competitive for funding by meeting the requirements of all supplemental information requests.

END NARRATIVE

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APPENDICES

A. Statewide Reporting Matrix

B. Communities At Risk

B1. Indicator Descriptions

C. State Map

D. Letters of Support

E. EBP Capacity Chart

F. Local Health Department Capacity Chart

G. Stakeholder Meeting Materials

H. Baltimore City Map- At Risk Communities

I. Baltimore City Capacity Assessment

J. CBCAP Summary and Programs

Appendix A

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0915-0333. Public reporting burden for this collection of information is estimated to average 24 hours per respondent, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-33, Rockville, Maryland, 20857

Indicator

Title

V

CAPTA1

Head Start2

SAMHSA Sub-State Treatment

Planning Data Reports

Other

Comments

Premature birth -Percent: # live births before 37 weeks/total # live births

11.0

--

--

--

2008, MD DHMH, Vital Statistics Administration (VSA)

Low-birth-weight infants -Percent: # resident live births less than 2500 grams/# resident live births

9.3

--

--

--

2008, MD DHMH, VSA

Infant mortality (includes death due to neglect) -# infant deaths ages 0-1/1,000 live births

8.0

--

--

--

2008, MD DHMH, VSA

Poverty -# residents below 100% FPL/total # residents

8.7

--

Not available

--

2008, U.S. Census Bureau

Crime - # reported crimes/1000 residents - # crime arrests ages 0-19/100,000 juveniles age 0-19

--

3582.8

--

--

--

41.5

2008, MD State Police

Domestic violence -Percent of Head Start participants receiving Domestic Violence Services

--

--

4.8

--

2008-2009 Head Start Prog Info Rep

School Drop-out Rates -Percent high school drop-outs grades 9-12

2.8

--

--

--

2008 MSDE

Substance abuse -Prevalence rate: Binge alcohol use in past month3 -Prevalence rate: Marijuana use in past month -Prevalence rate: Nonmedical use of pain relievers in past month - Prevalence rate: Use of illicit drugs, excluding Marijuana, in past month -Percent of Head Start participants receiving substance abuse prevention or treatment

--

--

7.9

21.7 4.9 3.9

3.1

2006-2008 SAMHSA National Survey on Drug Use and Health 2008-2009 Head Start Prog Info Rep

Unemployment -Percent of 2 parent families enrolled in Head Start not working -Percent of single parent families enrolled in Head Start not working

--

--

15.0

40.9

--

2008-2009 Head Start Prog Info Rep

Child maltreatment -Rate of indicated maltreatment (Total per 1,000 Population <18 yrs) (substantiated/indicated/alt response victim)4 -Rate of indicated maltreatment by type - Indicated – Physical Abuse - Indicated – Sexual Abuse - Indicated – Mental Injury/Abuse - Indicated – Neglect - Indicated – Mental Injury/Neglect -Percent of Head Start participants receiving Child Abuse and Neglect Services

--

4.3

1.0 0.8 0.0 2.5 0.0

25.5

--

2008 DHR, Child Protective Services (MD uses ‘Indicated’ instead of substantiated) 2008-2009 Head Start Prog Info Rep

Other indicators of at risk prenatal, maternal, newborn, or child health - Teen (15-19 years) birth rate per 1,000 population - % of births to women receiving late or no prenatal care

--

--

--

--

--

--

--

--

32.7

4.2

2008, MD DHMH, VSA 2008, MD DHMH, VSA

Appendix B. Communities At-Risk

JurisdictionCSA/ Zipcode Area Name

Percent

Preterma

Percent

LBWb

Infant Mortality

Ratec

Percent Families in

Povertyd

Crime

Ratee

Rate of Protective

Ordersf

Percent HS Drop-

outsg

Percent Ready to Enter

Schoolh

Subst Abuse Trtmnt

Ratei

Percent Unem-

ployedj

Abuse & Neglect Investig-ation

Ratek

Percent Late or

No PNCl

Teen Birth

Ratem

WIC Partici-pation

Raten

Medicaid Enrollment

Rateo

Total Number of Elevated

Indicatorsp

Maryland Avg 11.2 9.3 7.9 9.5 4316.5 77.8 3.0 81.6 7.1 7.0 1.6 4.3 33.0 16.8 112.0Baltimore City 1 Irvington 17.7 18.9 30.6 51.1 * 107.7 7.1 64.0 52.6 10.2 8.7 9.8 119.4 51.7 483.8 14Baltimore City 7 Cherry Hill 20.7 20.7 37.7 59.7 * 107.7 7.1 64.0 37.9 10.2 7.8 8.9 141.7 53.7 396.3 14Baltimore City 21 Mondawmin 18.9 20.0 23.0 44.1 * 107.7 7.1 64.0 45.4 10.2 5.4 9.9 135.5 48.6 436.6 14Baltimore City 23 Rosemont 18.8 20.0 27.6 45.7 * 107.7 7.1 64.0 52.6 10.2 5.7 10.6 135.5 51.7 483.8 14Baltimore City 24 Greenmount 23.8 20.4 20.8 65.9 * 107.7 7.1 64.0 51.6 10.2 10.1 9.1 133.3 67.2 496.5 14Baltimore City 33 Madison 18.5 16.8 28.7 57.2 * 107.7 7.1 64.0 51.6 10.2 10.1 8.0 137.8 67.2 487.8 14Baltimore City 45 Pimlico 21.5 18.8 18.2 44.0 * 107.7 7.1 64.0 33.3 10.2 5.3 8.6 99.5 43.3 362.1 14Baltimore City 47 Sandtown 21.9 20.0 27.6 56.5 * 107.7 7.1 64.0 52.6 10.2 6.2 8.2 200.0 51.7 483.8 14Baltimore City 51 Southwest 21.2 19.7 32.6 58.8 * 107.7 7.1 64.0 52.6 10.2 9.1 9.3 125.0 51.7 483.8 14Baltimore City 10 Clifton 23.8 20.4 * 57.2 * 107.7 7.1 64.0 51.6 10.2 10.1 11.5 137.8 67.2 496.5 13Baltimore City 17 Walbrook 18.6 18.3 29.7 39.9 * 107.7 7.1 64.0 33.3 10.2 * 11.1 124.4 45.0 374.6 13Baltimore City 30 Oldtown 23.3 25.6 * 68.0 * 107.7 7.1 64.0 51.6 10.2 8.8 8.1 200.0 67.2 487.8 13Baltimore City 35 Midtown 20.0 20.4 * 65.9 * 107.7 7.1 64.0 45.4 10.2 8.8 7.7 133.3 48.6 436.6 13Baltimore City 36 Midway 23.8 20.4 29.2 48.8 * 107.7 7.1 64.0 38.1 10.2 6.7 8.5 88.5 * 496.5 13Baltimore City 42 Patterson Park 18.6 16.8 28.7 48.8 * 107.7 7.1 64.0 51.6 10.2 9.6 * 144.1 67.2 487.8 13Baltimore City 46 Hollins Market 25.0 19.7 * 61.4 * 107.7 7.1 64.0 52.6 10.2 7.4 7.7 200.0 51.7 483.8 13Baltimore City 49 Southeastern 18.6 15.9 13.2 71.8 * 107.7 7.1 64.0 23.3 10.2 5.0 * 129.0 44.4 277.6 13Baltimore City 50 Park Heights 19.4 17.7 18.2 43.8 * 107.7 7.1 64.0 45.4 10.2 5.3 * 99.5 48.6 436.6 13Baltimore City 53 Upton 21.9 18.3 26.0 65.6 * 107.7 7.1 64.0 52.6 10.2 7.0 * 200.0 51.7 483.8 13Dorchester 21613 Cambridge 17.6 13.8 31.0 30.4 7124.7 * * 66.0 28.9 10.7 6.5 9.2 123.9 45.0 315.6 13Baltimore City 3 Edison 23.8 20.0 29.2 * * 107.7 7.1 64.0 38.1 10.2 5.6 * 131.1 45.3 496.5 12Baltimore City 4 Brooklyn * 13.9 * 50.0 * 107.7 7.1 64.0 37.9 10.2 8.2 10.2 137.3 53.7 396.3 12Baltimore City 9 Claremont 18.4 * * 56.9 * 107.7 7.1 64.0 51.6 10.2 5.6 11.5 137.0 67.2 496.5 12Baltimore City 13 Dorchester 18.6 17.7 * 43.8 * 107.7 7.1 64.0 33.3 10.2 * 14.1 99.5 45.0 374.6 12Baltimore City 19 Charles Village 20.0 20.4 * 48.8 * 107.7 7.1 64.0 32.9 10.2 6.7 8.0 103.6 * 391.7 12Baltimore City 43 Penn North 19.4 20.6 * 44.1 * 107.7 7.1 64.0 45.4 10.2 5.4 * 97.6 48.6 436.6 12Baltimore City 44 Perkins 23.3 25.6 * 68.0 * 107.7 7.1 64.0 51.6 10.2 10.1 * 200.0 67.2 496.5 12Baltimore City 54 Washington Village 25.0 20.7 * 47.9 * 107.7 7.1 64.0 52.6 10.2 8.7 * 141.7 51.7 483.8 12Baltimore City 55 Westport * 20.7 37.7 59.7 * 107.7 7.1 64.0 37.9 10.2 7.8 * 141.7 53.7 396.3 12Washington 21740 Hagerstown 15.0 13.8 * 46.2 * 115.2 * 73.0 19.1 9.7 11.5 7.9 145.2 42.6 257.5 12Wicomico 21801 Salisbury 16.6 15.5 16.1 42.3 10730.7 * 5.5 * 30.7 * 5.0 8.4 133.3 42.7 265.7 12Baltimore City 6 Cedonia 18.0 16.9 22.8 41.3 * 107.7 7.1 64.0 * 10.2 * * 89.9 45.3 496.5 11Baltimore City 15 Edmonson Village 20.9 18.3 * * * 107.7 7.1 64.0 29.8 10.2 5.0 * 124.4 45.0 374.6 11Baltimore City 27 Highlandtown 18.6 * * 39.1 * 107.7 7.1 64.0 23.3 10.2 * 8.7 144.1 44.4 277.6 11Baltimore City 31 Lauraville 20.6 19.0 26.7 * * 107.7 7.1 64.0 * 10.2 * 7.3 89.9 45.3 496.5 11Baltimore City 34 Hampden 20.0 * * 43.8 * 107.7 7.1 64.0 45.4 10.2 5.1 * 99.5 48.6 436.6 11Baltimore City 41 Highlandtown * * * 71.8 * 107.7 7.1 64.0 51.6 10.2 7.4 7.7 144.1 67.2 496.5 11Baltimore City 52 Waverlies 19.1 18.3 * 48.8 * 107.7 7.1 64.0 25.6 10.2 6.7 * 86.2 * 303.6 11Prince Georges 20785 Hyattsville 17.7 16.5 38.0 33.8 * 109.6 * 68.0 * * 3.6 22.1 111.9 35.2 259.9 11Baltimore City 2 Beechfield 20.9 17.4 30.6 * * 107.7 7.1 64.0 19.0 10.2 * * * 39.3 287.8 10Baltimore City 14 Downtown 25.0 * * 65.9 * 107.7 7.1 64.0 32.9 10.2 8.8 * 200.0 * 391.7 10Baltimore City 16 Fells Point * * 24.0 * * 107.7 7.1 64.0 32.9 10.2 * 15.4 200.0 44.4 287.7 10Baltimore City 20 Govans * 15.8 * * * 107.7 7.1 64.0 25.6 10.2 4.2 7.8 93.1 * 303.6 10Prince Georges 20706 Lanham 16.3 * 18.4 28.6 6870.1 109.6 * 68.0 * * 3.6 22.1 70.7 39.5 * 10Prince Georges 20743 Capitol Heights 17.7 17.4 38.0 25.2 8584.0 109.6 * 68.0 * * 3.2 14.2 75.2 * * 10Somerset 21817 Crisfield 16.3 14.0 19.9 34.6 * * * * 22.8 9.4 6.3 * 74.1 41.1 314.5 10

* Indicates rate < 1 standard deviation above mean

Appendix C. Indicator Descriptions (by ACA specified area)

Premature birth, Low birth weight infants, Infant Mortality (including death due to neglect), or other indicators of prenatal, maternal,

newborn, or child health risk

Percent Preterm Births: o Justification for selection: This is a standard, well understood indicator of poor birth outcomes. o Defined as: (# of births <37 weeks gestational age / total births) * 100 o Years represented: 2004-2008 o Measured at census tract level o Source: MD Department of Health and Mental Hygiene (DHMH), Vital Statistics Administration (VSA) o Limitations: Some addresses listed on the birth record could not be geocoded to a census tract, and were therefore not included in the

analysis. Rates were not computed for census tracts with fewer than 5 preterm births over the 5 year period.

Percent low birth weight infants: o Justification for selection: This is a standard, well understood indicator of poor birth outcomes. o Defined as: (# of births <2500 grams / total births) * 100 o Years represented: 2004-2008 o Measured at census tract level o Source: MD DHMH, VSA o Limitations: Some addresses listed on the birth record could not be geocoded to a census tract, and were therefore not included in the

analysis. Rates were not computed for census tracts with fewer than 5 low birth weight infants over the 5 year period.

Infant Mortality Rate: o Justification for selection: This is a standard, well understood indicator of community need. o Defined as: (# of infant (<1 yr) deaths / total births) * 1,000 o Years represented: 2004-2008 o Measured at census tract level o Source: MD DHMH, VSA o Limitations: Some addresses listed on the birth or death record could not be geocoded to a census tract, and were therefore not

included in the analysis. Rates were not computed for census tracts with fewer than 5 infant deaths over the 5 year period. There were no census tracts with more than 4 infant deaths due to neglect over the 5 year period, and it was therefore not possible to include a separate indicator for infant deaths due to neglect.

Percent Late or No Prenatal Care: o Justification for selection: This is a standard, well understood indicator of community need. o Defined as: (# of births to women receiving late (3rd trimester) or no prenatal care / total births) * 100

o Years represented: 2004-2008 o Measured at census tract level o Source: MD DHMH, VSA o Limitations: Some addresses listed on the birth record could not be geocoded to a census tract, and were therefore not included in the

analysis. Rates were not computed for census tracts with fewer than 5 births to women receiving late or no prenatal care over the 5 year period.

Teen Birth Rate:

o Justification for selection: This is a standard, well understood indicator of community need. o Defined as: (# of births to adolescents (15-19 yrs) / female population (15-19 yrs)) * 1,000 o Years represented: Births: 2004-2008, Population: 2000 o Measured at census tract level o Sources: Births: MD DHMH, VSA, Population: US Census Bureau o Limitations: Some addresses listed on the birth record could not be geocoded to a census tract, and were therefore not included in the

analysis. Rates were not computed for census tracts with fewer than 5 teen births to over the 5 year period. Population data at the census tract level is only available from the U.S. Decennial Census, and there are likely to have been substantial changes to the population in Maryland over the last 10 years.

o Poverty and Unemployment

Percent of Families in Poverty: o Justification for selection: This indicator seemed to more closely measure the poverty level of families likely to benefit from home

visiting programs than the broader total resident poverty level metric specified in the Home Visiting Program Supplemental Information Request.

o Defined as: (# of families with children (<18 yrs) with incomes below the poverty level / total # of families with children (<18 yrs)) * 100

o Year represented: 2000 o Measured at census tract level o Source: MD Department of Planning (MDP), US Decennial Census o Limitations: Rates were not computed for census tracts with fewer than 5 families with children under 18 years of age living below the

poverty level. Population data at the census tract level is only available from the U.S. Decennial Census, and there are likely to have been substantial changes to the population in Maryland over the last 10 years. The number of families living in poverty is likely to have increased due to the current recession.

Percent Unemployed:

o Justification for selection: This is a standard, well understood indicator of community need. o Defined as: (# of adults seeking employment / # of adults in labor force) * 100 o Year Represented: 2009 o Measured at jurisdiction level

o Source: MD Department of Labor, Licensing and Regulation (DLLR) o Limitations: This metric is only computed by MD DLLR at the census tract level immediately following a Decennial Census. MD

DLLR felt that the unemployment rates had increased across the state to such a great degree since the 2000 Census that it would be unwise to use the 2000 data.

WIC Participation Rate: o Justification for selection: Participants at the Home Visiting Stakeholder Conference that was held to review the Needs Assessment

strongly recommended adding this metric as a good way of identifying communities with women and children in need. o Defined as: (# of people enrolled in WIC / total population) * 1,000 o Years represented: WIC: 2005-2009, population: 2000 o Measured at ZIP code level o Sources: WIC enrollment: MD DHMH, Family Health Administration, WIC Program, Population: MDP US Decennial Census o Limitations: This metric was not available at the census tract level, but was available by ZIP code. Rates were not computed for ZIP

codes with fewer than 5 WIC participants over the 5 year period. Population data at the ZIP code level is only available from the U.S. Decennial Census.

Medicaid Enrollment Rate:

o Justification for selection: This indicator was added because it serves as an additional metric of poverty but has more recent data than the Census poverty information (at least for the numerator).

o Defined as: (# of people enrolled in Medicaid / total population) * 1,000 o Years represented: Medicaid: 2005-2009, population: 2000 o Measured at ZIP code level o Sources: MD DHMH, Medical Assistance Programs, MDP US Decennial Census o Limitations: This metric was not available at the census tract level, but was available by ZIP code. Rates were not computed for ZIP

codes with fewer than 5 Medicaid enrollees over the 5 year period. Population data at the ZIP code level is only available from the U.S. Decennial Census.

Crime Crime Rate:

o Justification for selection: This is a standard indicator of a community in need. o Defined as: (total offenses / total population) * 100,000 o Years represented: 2007-2008 o Measured at municipality and jurisdiction level o Source: Crime: MD State Police, Uniform Crime Report, population: MDP Census estimates o Limitations: Rates were not computed for municipalities with less than 50 reported offenses per year. The rates for Ocean City, and its

containing jurisdiction, Wicomico County, were adjusted to account for the seasonal tourist population influx.

Domestic Violence and Child Maltreatment Rate of Protective/Peace Orders:

o Justification for selection: Maryland does not currently have any direct measures of domestic violence. The Governor’s Office of Crime Control and Prevention recommended this metric as the best proxy indicator for domestic violence.

o Defined as: (# of protective and peace order filings / total population) * 10,000 o Years represented: 2008-2009 o Measured at jurisdiction level o Source: Protective/Peace Orders: MD Judiciary, population: MDP population estimates o Limitations: This measure is only available at the jurisdiction level. A new system is being developed which will allow police

departments to indicate when offenses are related to domestic violence. Data from this system may be available for future assessments.

Child Abuse & Neglect Investigation Rate:

o Justification for selection: Based on information from the MD Department of Human Resources (DHR), it was decided to combine indicated and unsubstantiated child investigations in order to compute more stable rates at the census tract level. DHR reported that both categories were indicative of child abuse and neglect. Maryland does not use the term ‘substantiated’.

o Defined as: (# of indicated and unsubstantiated child abuse and neglect investigations / total population) * 1,000 o Years Represented: Abuse/neglect: 2006-2009, population: 2000 o Measured at census tract level o Sources: MD DHR, US Census Bureau o Limitations: Some addresses in the DHR database could not be geocoded to a census tract, and were therefore not included in the

analysis. Rates were not computed for census tracts with fewer than 5 investigations over the 4 year period. It was not feasible to subdivide the investigations by allegation type due to small cell sizes at the census tract level. Population data at the census tract level is only available from the U.S. Decennial Census.

High School Dropout Rate

Percent HS Dropouts: o Justification for selection: This is a standard indicator of communities in need. o Defined as: (# of high school dropouts / total # of high school students) * 100 o Years Represented: 2008-2009 o Measured at jurisdiction level o Source: MD State Department of Education (MSDE) o Limitations: This measure is published by MSDE per high school, however because they were unable to identify the geographic areas

that feed enrollment to each school, it was not possible to map the rates at this level. Therefore, jurisdictional rates were used for this metric.

Percent Ready to Enter School:

o Justification for selection: School readiness was another metric that was widely recommended for inclusion in the needs assessment by the participants of the Home Visiting Stakeholders Conference. It was felt that this was an important measure of need in the early childhood area.

o Defined as: (# of children entering kindergarten ready to learn / total # of children entering kindergarten) * 100 o Year Represented: 2009-2010 School Year o Measured at jurisdiction level o Source: MSDE o Limitations: This measure is published by MSDE per elementary school, however because they were unable to identify the geographic

areas that feed enrollment to each school, it was not possible to map the rates at this level. Therefore, jurisdictional rates were used for this metric.

Substance Abuse

Substance Abuse Treatment Rate: o Justification for selection: Maryland does not have a good measure of substance abuse prevalence available at a community level. We

therefore decided to use substance abuse treatment rates as a proxy. We focused on women of childbearing age because we are working to get women into treatment before they become pregnant in an effort to improve pregnancy outcomes.

o (# of women (15-44 yrs) receiving ADAA-funded treatment for substance abuse / total # of women (15-44 yrs)) * 1,000 o Years Represented: Treatment: 2004-2008, population: 2000 o Measured at ZIP Code level o Sources: MD DHMH, Alcohol and Drug Abuse Administration, MDP US Decennial Census

Limitations: Rates of substance abuse treatment are only a proxy measure for substance abuse prevalence and may reflect better access to treatment in some areas. These data were not available at the census tract level. Population counts at the ZIP code level are only available from the Decennial Census.

Charles

Worcester

Talbot

Wicomico

Caroline

St. Mary's

Garrett

Frederick

Carroll

Baltimore

Kent

Harford

CecilAllegany

Dorchester

Montgomery

Howard

Somerset

Anne Arundel

Prince George's

Calvert

Washington

Queen Anne's

Baltimore City

Number of Elevated Indicators by CSA (Baltimore City) or ZIP Code, Maryland

Legend

# of Elevated Indicators(Maximum=15)

0

1 - 3

4 - 6

7 - 9

10 - 12

13 - 14

Prepared by MD DHMH, Center for Maternal and Child Health

Appendix C.

STATE OF MARYLAND

DHMH ATE OF MARYLAND

DHMH

Maryland Department of Health and Mental Hygiene Maryland Department of Health and Mental Hygiene 201 W. Preston Street • Baltimore, Maryland 21201 201 W. Preston Street • Baltimore, Maryland 21201

Martin O’Malley, Governor – Anthony G. Brown, Lt. Governor – John M. Colmers, Secretary Martin O’Malley, Governor – Anthony G. Brown, Lt. Governor – John M. Colmers, Secretary

Family Health Administration Family Health Administration Russell W. Moy, M.D., M.P.H., Director Russell W. Moy, M.D., M.P.H., Director

September 20, 2010 September 20, 2010 Audrey M. Yowell, Ph.D., MSSS Audrey M. Yowell, Ph.D., MSSS Health Resources and Services Administration Health Resources and Services Administration Maternal and Child Health Bureau Maternal and Child Health Bureau 5600 Fishers Lane, 18A-39 5600 Fishers Lane, 18A-39 Rockville, MD 20857 Rockville, MD 20857 RE: CFDA No. 93.505- Affordable Care Act (ACA) Maternal, Infant and Early Childhood Home Visiting

Program RE: CFDA No. 93.505- Affordable Care Act (ACA) Maternal, Infant and Early Childhood Home Visiting

Program Dear Dr. Yowell: Dear Dr. Yowell:

I am very pleased to submit the Department of Health and Mental Hygiene’s letter of concurrence and support for Part 2 of the Maryland’s response to Federal Opportunity Announcement HRSA-10-275, Affordable Care Act (ACA) Maternal, Infant, and Early Childhood Home Visiting Program. As you know, the Governor has designated the Department as the administering state agency for this new program. Within the Department, the Center for Maternal and Child Health (CMCH) is the State Title V agency, with responsibility for administering the federal MCH Block Grant as well as a number of related federal and state MCH programs.

I am very pleased to submit the Department of Health and Mental Hygiene’s letter of concurrence and support for Part 2 of the Maryland’s response to Federal Opportunity Announcement HRSA-10-275, Affordable Care Act (ACA) Maternal, Infant, and Early Childhood Home Visiting Program. As you know, the Governor has designated the Department as the administering state agency for this new program. Within the Department, the Center for Maternal and Child Health (CMCH) is the State Title V agency, with responsibility for administering the federal MCH Block Grant as well as a number of related federal and state MCH programs.

Since our initial submission (Part 1), we have been working closely with our key partners – the

Alcohol and Drug Abuse Administration here in the Department (State Single Agency for Substance Abuse), the Governor’s Office for Children (Maryland’s Children’s Cabinet), the Maryland Family Network (CAPTA Title II), and Headstart – on the federally required needs assessment for this new program. Separate letters from these partners are included with this submission.

Since our initial submission (Part 1), we have been working closely with our key partners – the Alcohol and Drug Abuse Administration here in the Department (State Single Agency for Substance Abuse), the Governor’s Office for Children (Maryland’s Children’s Cabinet), the Maryland Family Network (CAPTA Title II), and Headstart – on the federally required needs assessment for this new program. Separate letters from these partners are included with this submission.

We are very enthusiastic about this opportunity to work with our State agency and local partners to strengthen early childhood and home visiting systems that are critical for improving the health of families. We also look forward to working with you, your colleagues at the Administration for Children and Families, and with federal project staff at the central and regional offices. Please contact me at 410-767-6717 or [email protected]

We are very enthusiastic about this opportunity to work with our State agency and local partners to strengthen early childhood and home visiting systems that are critical for improving the health of families. We also look forward to working with you, your colleagues at the Administration for Children and Families, and with federal project staff at the central and regional offices. Please contact me at 410-767-6717 or [email protected] if you have any questions about this submission.

Sincerely,

Bonnie S. Birkel, RN, CRNP, MPH Director Center for Maternal and Child Health

Toll Free 1-877-4MD-DHMH • TTY for Disabled - Maryland Relay Service 1-800-735-2258

Web Site: www.dhmh.state.md.us

mailto:[email protected]






Appendix E. Evidence Based Capacity

CAPACITY ASSESSMENT: Maryland Early Head Start

What county (ies) does your program serve? Baltimore City, Baltimore County, Allegany, Anne Arundel, Caroline, Cecil, Talbot, Dorchester, Garrett,

Harford, Montgomery, Washington

Does the program have a name? Early Head Start

What home visiting model or approach is used? Home-based only. Weekly 90 minute home visiting or a monthly 90 minute home visit and attending the center 2x’s per week

Name the specific service(s) you provide. Comprehensive child development, health (including oral health), nutrition, social services, mental health, prenatal education

List the intended recipients of the service (e.g., pregnant women, infants).

Pregnant women, children ages 0-3

What are the targeted goals/outcomes of the intervention (e.g., child maltreatment reduction, maternal and child health, early literacy, reduction of domestic violence)?

Literacy, social competence, health, nutrition, mental health, and identification of children in high risk populations

What are the demographic characteristics of individuals or families served?

Must meet Head Start eligibility for age and income

How is the demographic data collected (e.g., intake sheet, questionnaire done by staff, self report…)

Done by staff

What is the number of individuals or families served per month?

Based on funded enrollment. For FY 2010, 296 statewide

What is the geographic area served (e.g., entire county, certain neighborhoods, or zip codes)?

Entire counties in Allegany, Anne Arundel, Caroline, Cecil, Talbot, Dorchester, Garrett, Harford, Montgomery, Washington; South East Baltimore City, Eastern Baltimore County

Are you state or federally funded?

Federally funded and state funded

What is your current funding for this fiscal year?

About $6.5 million for all of Head Start- which includes Early Head Start

CAPACITY ASSESSMENT: Nurse Family Partnership What county (ies) does your program serve? Garrett County

Does the program have a name? Garrett County Nurse-Family Partnership (GC NFP)

What home visiting model or approach is used? Nurse-Family Partnership (NFP National Service Office contracts with the GC Partnership/LMB to provide GC NFP)

Name the specific service(s) you provide. RN Nurse home visiting - prenatally and postnatally until the target child is age 2


Low income (MCHP eligible), first-time mothers (no previous live births) up to 28 weeks gestation are eligible for enrollment. Target children are served up to age 2. All services are voluntary.


NURSE-FAMILY PARTNERSHIP GOALS 1. Improve pregnancy outcomes by helping women engage in good preventive health practices, including thorough prenatal care from their healthcare providers, improving their diets, and reducing their use of cigarettes, alcohol and illegal substances 2. Improve child health and development by helping parents provide responsible and competent care 3. Improve the economic self-sufficiency of the family by helping parents develop a vision for their own future, plan future pregnancies, continue their education and find work Consistent program effects found in 2 or more randomized controlled trials: Improved prenatal health Fewer childhood injuries Fewer subsequent pregnancies Increased intervals between births Increased maternal employment Improved school readiness


For NFP clients enrolled in FY 2010: 100% were first-time mothers 100% White (the county is 98% White) 75% enrolled at or prior to 12 weeks gestation; 100% by 28 wks. gestation Median household income = $17,500 42% of mothers were unemployed 20% of mothers had less than a high school education 63% were age 19 or younger 57% smoke cigarettes 27% had a mental health concern


Demographic data is collected at intake and periodically by staff on tablet computers utilizing computerized data collection forms adapted from the NFP National Service Office forms. The NFP client forms are downloaded from a flash drive and then manually entered into an online web-based client information system (the NFP CIS).


97 families served in CY ‘09 93 families served in CY ‘10 (1st 6 mos.) 119 families and 92 children served between 8/23/2007 and 6/30/2010 68 families with 57 target children currently being served (this is a 6/30/10 snapshot)

What is the geographic area served Entire county Are you state or federally funded? State What is your current funding for this fiscal year?

$282,000 – Garrett LMB CPA funding from the MD Governor’s Office for Children $120,000 - MD Health Resources Commission grant to the GC Health Department to expand the GC NFP

CAPACITY ASSESSMENT: Parents as Teachers There are only two PAT programs in our state. All other programs use the PAT curriculum as part of the home visiting program

What county (ies) does your program serve? Garrett County, Somerset County and the 21852 zip code in Pocomoke

Does the program have a name? Parents as Teachers (PAT)

What home visiting model or approach is used? Parents as Teachers (national affiliation)

Name the specific service(s) you provide. The Parents as Teachers Born to Learn™ curriculum is provided during home visits to: a) Older siblings ages 3-5 of currently enrolled Healthy Families families b) At-risk families discharged from Perinatal (short-term) or other Early Care services that request continued support c) Almost all families receiving HFGC home visiting voluntarily participate in PAT. PAT activities are provided during the

HFGC home visits. List the intended recipients of the service (e.g., pregnant women, infants).

Families with young children birth to age five enrolled in HFGC and previously served families now enrolled in PAT only.


PAT Goals: Goal #1: Increase parent knowledge of early childhood development and improve parenting practices Goal #2: Provide early detection of developmental delays and health issues Goal #3: Prevent child abuse and neglect Goal #4: Increase children's school readiness and school success Independent randomized controlled trials (RCT) have consistently confirmed the effectiveness of Parents as Teachers. PAT has been shown to be effective by:

improving children’s development across multiple domains increasing school readiness improving parent knowledge of early childhood development and parenting practices identifying delays and health issues preventing child abuse and neglect


Garrett Co. For the 100 PAT families served in FY ’10: 42% were teen moms (age 19 or younger) at intake 74% had an annual household income under $20,000 70% were single parents 69% were first-time mothers 41% had less than a HS education 43% were unemployed at intake

Somerset: For the 100 PAT families served in FY ’10: 13-38 year old mothers 66% African American 4% Hispanic 30% Caucasian


Demographic data is collected during the referral process and at intake utilizing locally-developed data collection forms. This information is entered into a locally-developed MS Access database.


FY 2010: Garrett and Somerset 200 families participated in PAT

What is the geographic area served Entire counties of: Garrett County, Somerset County and the 21852 zip code in Pocomoke

Are you state or federally funded? State

What is your current funding for this fiscal year?

Garrett: A Maryland ADAA grant of approximately $60,000 to the local HD funds the PAT component for older siblings of Healthy Families Garrett County Families. PAT is infused into HFGC also – with no additional funding.

Somerset: $42,6893.00

CAPACITY ASSESSMENT: Healthy Families Maryland

What county (ies) does your program serve? Baltimore City and the following Counties: Baltimore, Calvert, Charles Dorchester, Frederick, Garrett, Howard, Lower Shore, Prince Georges, Montgomery, Queen Anne’s/Talbot, Washington, Wicomico

Does the program have a name? Healthy Families

What home visiting model or approach is used? Healthy Families America

Name the specific service(s) you provide. Nurse/Para-professional home visiting prenatally and/or until the target child transfers out to another early childhood program or reaches age 5. RN nurses provide staff supervision, administer assessments, and provide mental health services, as indicated.


At-risk pregnant or parenting families (with an infant up to age 3 months), (except first-time, low-income mothers who enroll prior to 28 weeks gestation) are eligible for enrollment. All services are voluntary. Families scoring 25+ on “The Family Survey” are offered services, and home visits must begin before baby is three months old and are weekly for at least six months.


Healthy Families America Program Goals: To systematically reach out to parents to offer resources and support To cultivate the growth of nurturing, responsive, parent-child relationships To promote healthy childhood growth and development To build the foundations for strong family functioning Outcomes from randomized control trials and quasi-experimental research are:

Reduced child maltreatment; Increased utilization of prenatal care & decreased pre-term, low weight babies; Improved parent-child interaction and school readiness; Decreased dependency on welfare, or TANF (Temporary Assistance to Needy Families) and other social

services; Increased access to primary care medical services; and Increased immunization rates.


Most parents are low income and between the ages of 17-35; in some areas up to 25% are non-english speaking


Demographic data is collected during the referral process and at intake utilizing locally-developed data collection forms. This information is entered into a locally-developed MS Access database.


FY 2010: 81 mothers, 79 fathers and 94 target children were served


Entire counties of: Baltimore, Calvert, Charles Dorchester, Frederick, Garrett, Howard, Lower Shore, Prince Georges, Montgomery, Queen Anne’s/Talbot, Washington, Wicomico and In Baltimore City: West Baltimore, Druid Heights, Upton, Mondawmin, Reservoir Hill and parts of Rosemont

Are you state or federally funded? State and/or [Federal] TANF funds What is your current funding for this fiscal year?

Varies by county from $300,000 to $800,000

Appendix F. LHD Capacity Chart Name of local health department

Allegany Allegany Calvert County Calvert County Carroll County Carroll County Carroll County

Cecil County Charles County Dorchester County

Name of home visiting programs that serve your county.

Allegany County Infants and Toddlers Program

Perinatal Substance Use Intervention Program

Maternal Child Program

Children With Special Health Care Needs Program

Maternal Child Health

Children with Special Health Care Needs

Chronic Disease Management Program

Healthy Start- County Funded

Maternal/Child Health/Healthy Start

Healthy Families—Beth Nossick Infant & Toddler—BOE—Donna Greenleaf Infant & Toddler—DCHD—Yvonne Church, Ruth Baker Early Head Start—Shore-Up—Director vacant Healthy Start/Baby Matters—Yvonne Church Children with Special Health Needs (nursing Component)—Carolyn Hallowell

Does your home visiting program serve any other counties?

No

No

No

No

No No

No

No

No No

What home visiting models or approaches are used?

Governed by state and federal polices and procedures

Infant and Toddlers portion- state and federal policies and procedures. Substance using prenatal and postpartum women- based on Dr. Chasnoff’s evidenced-based findings and recommendations-4Ps.

Targeted nurse home visiting case management Follow the Healthy Start Nurse home visiting model with local modifications to meet the needs of the county

Single point of entry program that provides care coordination and home visiting nurse case management to children with special needs and their families to facilitate access to health care and services

Case management, health assessments, health education & instruction, linkages to services

Education, advocacy & linkages to medical & health services, educational programs and respite care

Short term case management, patient assessment, health education and instruction, linkages to medical & health care support services

Modeled after original HS program-try to see pregnant women a minimum of 1X/trimester, more as needed. Infants up to 2 years of age Postpartum moms are usually seen once to confirm 6 weeks check and birth control. Pregnant drug abusing women are given priority followed by teens All of this is dependent on staffing and continued funding

The Healthy Start model

Healthy Families—Healthy Families America Early Head Start—Parents as Teachers

Name the specific service(s) you provide through the LHD.

Monthly nurse service coordination, non-clinical.

Monthly nurse service coordination, non-clinical.

Maternal Case Management (pregnant women) Child Case Management (Newborns up to age Two)

Care coordination Case management Nurse home visits Community and provider outreach

MCHP, ACCU, WIC, FP, CD, Infants & Toddler, Child Immunization Clinic, CSHCN, Health Education, Addiction Services, partnership with

MCHP, ACCU, WIC, Infant & Toddler, Health Education, Child Dental Services – all referred to by the CSHCN program

SCSM Program refers to Adult Education ad Review Services and Medial Assistance Personal Care Services

See above

Medical case management where residents of Charles County receive education and guidance regarding medical

Healthy Families (information already completed and sent by Beth Nossick—a copy of her responses is included) Screening, referral, assessment, intensive home visiting, quarterly newsletter. Visits focus on attachment,




Provide intensive case management to high risk pregnant women and children who are at greater risk for poor health outcomes without nurse intervention

local Hospital for OB care for undocumented pregnant women, child dental services – These are all services that MCH may refer/ link patients

insurance and resources, health education for a healthy pregnancy outcome, and infant/child health and safety, education regarding community resources, and advocacy with the goal of ensuring that the client is linked to all necessary resources and services. These services are provided face to face, by mail and telephone.

nurturing, positive parent-child interaction, healthy childhood growth and development.


Special needs infants, toddlers and pre-schoolers, birth to age five.

Infants and Toddlers- via I&T program. Prenatal and postpartum women with positive substance use during current pregnancy or infant test positive for substance exposure.

All high risk county residents that include: Pregnant Women, Post Partum Women, Newborns and Children up to age two

All children with special health care needs and their families ages 0-21

High-risk pregnant women & infants/ babies up to one year of age and children up to 2 years of age.

Pre-school and school age children with newly diagnosed medical conditions, acute episodes of chronic health problems, functional cognitive and learning disabilities

Adults, age 19 years and older, with chronic health problems

Pregnant and postpartum women and children up to 2 years of age

Women who are pregnant or post delivery and families with children under the age of 2 years.

Pregnant women/women with newborns. Home visits must begin before baby is three months old and are weekly for at least six months

What are the targeted goals/outcomes of the intervention (e.g., child maltreatment reduction, maternal and child health, early literacy, reduction of

Eliminate or reduce developmental delay outcomes related to diagnosis.

Infants and Toddlers- Eliminate or reduce effects of substance exposure or addiction in infants. Prenatal women-

Healthy Pregnancies Injury Prevention Decreased fetal and infant mortality Prevention of poor pregnancy outcomes Reduction of

All children with special health care needs will attain their highest level of physical and mental health

Maternal & Child Health/ Wellness practices. Immunization compliance Parent education and skills Growth and development milestones

Nursing case management & resource coordination for pre-school and school age with special health care needs necessitating nursing, medical, and psychosocial management,

Improvements/ stabilization of chronic health problems, promotion and implementation of wellness practices

Reduce infant and fetal mortality. Promote maternal and child health. Prevention of child maltreatment.

Healthy pregnancies with a healthy birth outcome (reducing infant mortality), infant/child safety in the home, overall health education

Child maltreatment prevention/reduction; child health & safety; school readiness is a long-term goal




domestic violence)? referral and treatment for substance use during pregnancy and maintenance after delivery; and other support services as needed. Postpartum women- Referral to addictions and family planning services; and other support services as needed.

maternal drug use

Smoking Cessation/ drug abuse abstinence Family support and advocacy Health education School Health services Community outreach Provider Visits

interventions and linkages to needed services, contacts/ resource coordination with medical providers, identify and support respite care

for healthier families and improved health for women for future pregnancies.


All children who qualify based on program eligibility set by the state. Insurance is not a factor.

Pregnant women, infant and postpartum women with substance use/exposure.

FY 2010 – total new referrals – 403 369 – Pregnant women on medical assistance 330 – number of individuals served White- 273 (82%) Black -93 (23%) Hispanic – 14 (4%) Asian – 4 (1%) Biracial – 1 Unknown – 15 (4%)

Total – 58 White -39 26 – female Black - 17 32 – male multi -1 Indian -1 < 1yr - 16 1-2 - 6 3-9 -21 10-15 -12 16-18 -2 19 -1

High risk pregnant women and their babies and young children

Pre-school and school are children, families needing assistance with accessing medical, health, and respite care including financial support

Patients referred to CDCM Program need monitoring of blood pressure, diabetic testing, medication instruction & management, health & nutrition education, and community resource planning

Characteristics and demographics cover our entire county and any pregnant woman and their children. Most of the participants have Medical Assistance, but we do have some mothers with private insurance

The eligible population are all Charles County residents, regardless of legal status, so the characteristics span all income levels, races and religions.

FY10: MOMS - 16% under 18; 18% 18-19; 56% 20-30 yrs old; Average age 23.1; Age range 14 – 38; 65% Black; 31% White; 4% Hispanic;78% single; 44% less than HS diploma; 31% Diploma or GED; 11% in school; 7% full-time employed; 11% part-time employed; 51% unemployed, not looking; 20% unemployed, but looking; 51% household income < $10,000; 20% income btwn $10,000-20,000; 93% English speaking; 4% Spanish speaking.

How is the demographic data collected (e.g., intake sheet, questionnaire done by staff, self

This is done by the main office/agency within Allegany County-the Board of Education.

Infant Toddlers data is collected by main agency-BOE Prenatal and postpartum

Maryland Prenatal Risk Assessment Nurse Risk assessment with client self reporting

Intake sheet by nurse

CCHD Nursing Bureau Referral Form MCH Referral Routing Resource Education Form

Referral form (CCHD Nursing Bureau), provider consultation, family contact, Special Needs Care Coordination Form

AERS evaluation forms, referral form Patient/ family contact, provider consultation

MPRA and new pregnant MA recipients info followed by nurse interview and chart forms that include

Professional partners complete the Maryland Prenatal Risk Assessment or the Local

Assessment Workers collect some demographic data at time of their initial visit; additional data collected by Support Workers if family enrolls for HV services.




report…) women data is collected is collected by, intake sheet and self report via MD Prenatal Risk Assessment

demographic information

Services Request depending on the client, residents may also refer themselves and in that situation the agency staff would collect the information, additionally referrals are accepted from internal partners in the agency.


Entire Program caseload is 115. Local health department provides service coordination for approx. 65% of caseload- 2.1 nursing FTE. (6) of these are in the extended 3-5 option.

(1) Nurse position in this grant: Infants and Toddlers- 25 substance exposed/affected infants and toddlers/month Prenatal- approx. 8-10pregnant women with substance use/month Postpartum- approx. 12 postpartum/month (woman testing positive at labor and delivery or infant tested positive)

120 – average active case load per month

Average active caseload 30 to 40 per month 65 – total number of children case managed

Average : 20 individuals/ month (one nurse in the program)

Average: 9 children/ month (one nurse in the program)

16 patients (3 nurses – each 1day/week in program)

The average number of individuals serviced in the last half of FY10 was 75 per month. This number does not include those that were contacted and refused the service.

123 35-45 depending upon service level

What is the geographic area served (e.g., entire county, certain

Entire county

Entire county

Entire county

Entire county

Entire county Entire county

Entire county

Entire county

The entire county.

Entire county




neighborhoods, or zip codes)?


Infant and Toddlers grant to the BOE funds only 8 hours/week for providing a nurse to service coordinate the extended option- age 3-5. Traditional service coordination providers funded and employed by the LHD are possible through DHMH grants, MCHRC partial grant and health department CH core funding.

Joint funding by DHMH-MCH and MCHRC

no

State

State and Federal State and Federal

State

County

The program is funded by county, state and federal resources.

State

What is your current home visiting funding for this fiscal year?

In order to continue its commitment to the interagency program with the BOE and DSS, the health department contributes approx. $225,000/year for service coordinators and support staff.

$93,677 joint ($40,000 DHMH-MCH supplemental, $40,000 MCHRC and Medicaid collections for Infant and Toddler service coordination- $13,677.

Local Funding

State

$281,657 – MCH Budget

CSHCN Budget - $41, 209

$31,622

$132,279

$113,000.00 F371N--$363,132

Name of local health department

Dorchester County

Dorchester County

Dorchester County



No

No

No

What home visiting models or approaches are used?


Infant & Toddler (nursing component) Screen, assess and identify children birth to age 3 to determine developmental delays and to coordinate and secure a program of therapy and treatment in areas of identified need

Healthy Start/Baby Matters/Core Child Health Complete a health and environment assessment and/or to offer further education and counseling on nutrition, smoking, drug use, family planning and parenting skills

Children with Special Health Needs (nursing component) Assessment and evaluation of children with special health needs requiring a nursing plan of care. Home visits are made if child is not yet in school.


Individuals with 25% developmental delay or a diagnosed physical or mental condition that puts them at risk for delay

*Pregnant women with MA and risk factors *Infants/children with MA under 2 yo with risk factors

Any child identified by the Board of Education that requires a nursing plan of care be developed.

What are the targeted goals/outcomes of the intervention (e.g., child maltreatment reduction, maternal

Child health school readiness

Child maltreatment reduction; maternal & child health

Child health; school readiness


Dorchester County

Dorchester County

Dorchester County

and child health, early literacy, reduction of domestic violence)?


FY ’10-8 children/8 families

FY ’10—36 children; 71 families

22 children


Interview, assessment sheet

Interview, prenatal risk sheet

Nursing assessment


8 children receive a home visit every 1 – 3 months, depending on need

Each woman and/or child gets at least two visits a year

Funded for 20, current case load is 22


Dorchester County

Dorchester County

Dorchester County


Entire county

Entire county

Entire county


No funding—in kind service with BOE

Federal/Special/County

Federal


$0

F564N--$10,000 F416N—36,801 E816N--$25,922 (county)

F675N--$12,000


Frederick County

Harford County Howard County Montgomery County


Queen Anne’s County

Somerset Washington County

Wicomico County

Worcester County


Healthy Start Case Management Program: a telephonic CM program with opportunities for face to face contact with the client.

none

Family OPTIONS Program

DHHS PHS/CHS Nurse Case Management Program. Family Services, Inc. Healthy Families Family Services, Inc, Early Head Start. Family Services, Inc., Help Me Learn Program. Montgomery County Infants and Toddlers Program, SMILE, the African American Health Infant Mortality Reduction Program Mental Health Association’s Families Foremost Center Early Head Start Program at the Reginald S. Lourie Center for Infants and Young Children

Healthy Start/Infant at Risk Programs

1.Healthy Families Queen Anne’/Talbot 2. Parents As Teachers 3. Family Support of Queen Anne’s County 4. Even Start

Babies Born Healthy Home Visiting (BBH) BabyNet Home Visiting (BN)

Healthy Families of Washington County Maternal and Child Home Visiting Early Head Start Washington County Family Center Parent-Child Center Judy Center

Healthy Families Wicomico

1. Early Care: (WCHD) 2. Healthy Families Lower Shore: 3. HIPPY (Home Instruction Program for Youngsters: (MSDE) Judy Center 4. Family Preservation Program, Families Now, Family Stabilization Services 5. Infant and Toddler Program:(WCHD) 6. Early Intervention Services (WCHD): Mental Health Program 7. Early Head Start/ Head Start (Shore UP)


No

No

No

No

No

Healthy Families QA/T serves Queen Anne’s and Talbot counties.

No No

No

No

What home visiting models or approaches are

The program is modeled after the State Healthy Start Program

None

Nurturing program for teen parents and their children

Healthy Families is the only national model

Approach is Nursing assessment by telephone or

Healthy Families America, Parents as Teachers

Home visits based on an educational model that includes

RNs provide case management services.

Uses Healthy Families model (this site is accredited through

Early Care is based on the State of Maryland’s previous Healthy


Frederick County





Wicomico County

Worcester County

used?

hospital bedside for risks for healthy pregnancy and/or infant outcomes and early Nursing home visiting intervention and follow-up for teaching and resource connection.

anticipatory guidance provided by community health nurses; provides linkage to resources and other community services as indicated

Depending on the needs of the clients, nurses may visit monthly or every 3 months.

September 2014 by the national service office, Healthy Families America)

Start program.


Comprehensive care coordination services Assist access to MCHP/MA Assist access to OB and PCP services Telephonic Case Management with opportunities for face to face contact at intake clinic, FMH Prenatal Center or coordinated with a visit to the LHD. Facilitate linkages to community agencies and resources. Prenatal education to Hispanic pregnant women – (Healthy Journey Class) who are not eligible for CM services.

administrative desk top case management

Case management; In home prenatal and parenting education; Weekly curriculum based psychoeducational group sessions

Community Health Services provides HV /case management uninsured prenatal women and children Care Coordination, immunizations/flu administration, Lead Prevention Program, pregnancy tests, emergency preparedness training and activities, dental services. Contract out Reproductive Health, Clinical Maternity Service to low income, uninsured

Nursing home visits to high-risk pregnant women to assure adequate pregnancy follow-up for prenatal care, WIC etc, and teaching and support about pregnancy; Assessment and early intervention at the birth hospital bedside; follow-up inter-conceptual and infant Nursing home visits to provide parenting support and education, to assess infant health and safety in the home and to assure connection to needed services;

Healthy Families QA/T

Home visiting standard is: BBH: Pregnant women: 2 prenatal home visits, one PP home visit Infants: monthly for first 6 months of life; again at 9 mos. and 12 mos. BN: Pregnant women only (undocumented and uninsured): one prenatal and one post-partum home visit Additional visits may occur based on individual need Program addresses medical, nutritional and psychosocial factors and assists participants to access healthcare and related services, practice healthy behaviors, and good parenting skills

Maternal and Child Home Visiting

Intensive weekly home visitation of pregnant and parenting mother to prevent child abuse and neglect through age 5 of child. Utilizes paraprofessionals as Home Visitor and nurse as consultant/performs assessment

Early Care, Infant and Toddler, and Early Intervention are the home visiting programs provided through the health department to the target population (pregnant women and children).


Frederick County





Wicomico County

Worcester County


Pregnant, postpartum women, infants & children up to the age of 2 yrs that are MA eligible or potentially MA eligible

Eligible or potentially eligible Medicaid recipients (includes pregnant women and children)

Pregnant (18 yo and under) and parenting teens; Infants to age 2; Fathers of the baby

Pregnant and postpartum women, infants and children, dental services to children, maternity adults and seniors

At-risk pregnant women, postpartum/interconception women and at-risk infants to age 2 who live in the County.

Pregnant women through the child’s 5th birthday.

BBH: Medicaid pregnant women and infants at risk for poor health outcomes BN; Undocumented (therefore uninsured) pregnant women

High-risk pregnant women and children up to 2 years of age. First time mothers Adolescents 18 years of age or less Alcohol/Drug use Disability (mental/physical/developmental) History of abuse or violence History of fetal/infant death Homelessness Late registration or no prenatal care (> than 20 wks. Gestation) Lack of social/emotional support Less than 1 year since last delivery Mental Health (Current or Hx)

Pregnant and parenting women under age 25 Infants and children to age 5

Early Care is the only home visiting program offered through the health department targeting pregnant women. All three, as listed above, target infants and/or children.


Maternal and child health Improving access to early and continuous prenatal care Reduce the incidence of premature and low birth weight births Reduce infant mortality and morbidity

Maternal and child health

Reduction of child abuse and neglect; Reduction of out of home placements; Promotion of child and family health; Optimal child development; Reduction in the incidence of repeat teen

DHHS programs- Reduce infant mortality, preparing children to live and learn, Healthy Mothers and Babies

Reduction of infant mortality (reducing SIDS and other infant deaths), reducing low birth weight and premature births; improving maternal and child health and psycho-social outcomes in a high risk population; assuring

Reduce the occurrence of child abuse and neglect, build the capacity of first time parents to raise a young child who will have the social, emotional, language and learning skills to be ready for school, and to improve parenting

Improve maternal health, birth outcomes, reduce infant mortality, establish a medical home for infants

Decrease in pre-term deliveries Decrease in Fetal and Infant mortality Increase in access to preventive healthcare services Decrease in subsequent teen births Decrease in incidence of child

To prevent child abuse and neglect, to assure children enter school ready to learn, parent to complete GED and have employment and/or further education, promote positive parenting skills, children have a medical home and

The goal of the Early Care program is the reduction of infant mortality, low birth weight babies and elimination of the racial disparities that exist in these perinatal outcomes.


Frederick County





Wicomico County

Worcester County

pregnancy/birth; Early literacy

connection to a medical provider and needed services.

outcomes.

abuse and neglect

are current with well baby visits and immunizations.


County resident MA or potentially MA eligible Psychosocial risk or first time mom Hx of preterm or low birth weight birth

Medicaid or potentially Medicaid eligible

Teens 18 yo and under: 13% 13-15 yo; 70.3% 16-18 yo; 10.8% over 19 yo; Multiracial: 8.1%; Hispanic: 13.5%; Caucasian: 27%; African American: 51%

Low income, uninsured Immigrant, non-English Speaking

75% African American, 18% Latino, 11% white,1%other Mainly low income, Medicaid eligible, uninsured and underinsured clients

22%- under 18 yrs old 23%- 18-19 yrs old 50%- 20-30 yrs old 5%- over 30 yrs old 23%- African American 38% Caucasian 37%- Hispanic 2%- Multi-racial 56% Single 38%- Living together 3%- Married 3%- Other 7%- less than 7th grade education 42%-8-12th grade 21%- HS diploma 2%- GED 25%- some college 18%-FT employment 21%-PT employment 7%- Student 12%- Looking for employment 33%- Not looking 8%- Disabled

BBH: Somerset County Medicaid recipients with a targeted risk factor that increases the risk of a poor outcome BN: All pregnant women eligible for home visiting

The majority of the recipients are white, single parent females with low incomes/poverty level. Maternal ages range from 15 to 40.

Target low income (Medicaid or Medicaid eligible) women under age 25 who receive a positive score upon full assessment that indicates that they are at risk for child abuse/neglect.

Early Care serves pregnant women and infants less than one year of age who are recipients of Medical Assistance and who at the highest risk for poor birth outcome.

How is the demographic data collected (e.g., intake sheet, questionnaire done by staff, self

Intake sheet and entered onto excel database

Intake sheet

Initial referral intake using Maryland Prenatal Risk Assessment (MPRA) form generated by

Through Service Eligibility and/or nurse assessment

Intake/assessment sheet

Data collected through questionnaire completed by staff member

Health Department risk evaluation form completed on women accessing HD pregnancy related services and provider

Demographic information is collected through staff interview.

Intake form completed by staff

There is an intake assessment completed for all clients.


Frederick County





Wicomico County

Worcester County

report…) medical providers; Referrals from Social services, Juvenile services, school system and self; Comprehensive information obtained from the Nurturing program social history questionnaire

referral via the Maryland Prenatal Risk Assessment Infants are identified at the PP home visit or via community referral


Average per month = 107

Very limited home visits with ACCU / Hs funds

20-25

For all services provided in the two area DHHS health centers, 1617/mo For HV/CM of prenatal women and children in FY 10, maternity 2027, children 2259 Unable to estimate the number of individuals services in all PH programs

An average of 200 families per month

Families served per month is approximately 80-100 depending on the levels of service provided.

Pregnant women: average of 40 per month Infants: average of 31 per month

25-30

40

This varies. The average case load in FY2010 was 43 clients/month open to care and an average of 29 clients/month pending (follow-up efforts).


Entire county

Entire county

Entire county

The entire county

Entire County

Healthy Families QA/T serve the entire counties.

All Somerset residents served

Entire county.

Wicomico County

Early Care serves the entire county.


State CORE

ACCU and HS funds

Federal grant administered through the local Department of Social Services

County Funded

State and County funded

Healthy Families QA/T receives TANF funds through MSDE and administered through both counties Local Management Boards. Both counties Local Management Boards provide additional state

State and county funds support the programs

State funded.

Funded through MSDE

Early Care is supported by county funds.


Frederick County





Wicomico County

Worcester County

funds to support the program. Beginning FY 11 the Queen Anne’s portion of the program receives state funding through Department of Human Resources to serve families residing in Queen Anne’s county only.


County and State CORE

Limited for home delivery verifications

$85k

unknown Funding is not broken out for the home visiting intervention.

State: High Risk Infant:$117,645. Local/CORE Healthy Start: $1,395,700.

Healthy Families QA/T budget for both counties is $500,594

$176,000.00

$122,669

$283,448.00

We only have funding for one nurse for the entire county. This significantly limits the case load and level of care. Home visits more often than once every three months are limited to those clients at greatest risk of those at highest risk that qualify for the program. Months that visits do not occur, phone contact is attempted and/or a mailing occurs. Office visits are also coordinated with WIC appts.

Name of local health department Baltimore City


See below


No

What home visiting models or approaches are used? The Maternal & Infant Nursing Program uses a standardized curricula series called Partners for a Healthy Baby. All services are provided by registered nurses and licensed social workers who work as a team. Cases are assigned by discipline. For example, cases with medical problems are assigned to a nurse as the primary case manager while mental health and domestic violence cases are assigned to a social worker. Each client, however, will be assessed by both the nurse and the social worker. The variety of home visiting programs and the models used can be seen in the attached chart.


All M&I clients are referred to the following Baltimore City Health Dept. agencies as needed: Infants and Toddlers, Family Planning , STD Clinics , WIC and other agencies.


Pregnant women (and families) and infants 0-2 with early discharge at 1 year also possible


Improved birth outcomes (reduce pre-term birth, low birth weight birth, and deaths due to unsafe sleep practices). Also have infant development indicators.


Low income, Medicaid eligible, high-risk (see attached triage criteria)


All data is collected using a standardized assessment tool during the home visit. Data is entered into a database.


M&I serves approximately 300 families each month


M&I is citywide with the exception of the Federal Healthy Start areas listed in the chart below


M&I is state funded


Home Visiting Program Contact Information Target Area Served Baltimore City Healthy Start, Inc. Alma Roberts

Phone-410-396-7318 Sandtown-Winchester/Harlem Park; Greater Rosemont; Middle East; Highlandtown; Greater Greenmount Census Tracts: 202, 301, 601-604; 701-704; 803.01; 803.02; 804; 806-808, 907-909, 1001-1004, 1204-1205, 1501-1502; 1601-1604; 1605-1607;

DRU Mondawmin Healthy Families Dr. Barbara Hughes 410-225-3555

Druid Heights/Reservoir Hill/Upton; Mondawmin Census tracts: 1301; 1302; 1303; 1402; 1403; 1503; 1504; 1506; 1507; 1702; 1703

The Family Tree Carolyn Finney 410-889-2300 ext 1202

Allendale/Irvington/S. Hilton; Beechfield; Morrell Park; Violetville Census Tracts: 2007.02; 2008; 2501.01; 2804.01, 2804.03, 2804.04

Bon Secours Foundation of Maryland Lori Fagan 410-362-3629

West Baltimore Census Tracts: 1803; 1902; 1903; 2003; 2005; 2004; 2002

Peoples Community Health Ctrs. Wanda Irving 410-467-6040 ext 2021

Pigtown Neighborhood, Carroll Park, Washington Village Census tracts: 2101 and 2102

Maternal and Infant Nursing Program Rebecca Dineen 410-396-9404

City-wide

Sinai Hospital Pam Young 410-601-5314

Park Heights Census tracts: 1512, 1513, 2716, 2717, 2718.01, 2718.02

Baltimore Medical Systems Pam Brown 410-558-4946

BMS clients

Maryland Home Visiting Stakeholder Meeting Rice Auditorium, Spring Grove Hospital campus

August 9, 2010

Rena Mohamed, Meeting Facilitator

Agenda 8:30 AM Registration and Continental Breakfast 9:00 AM Welcome and Purpose Bonnie S. Birkel, Director

DHMH Center for Maternal and Child Health Rosemary King Johnston, Director Governor’s Office for Children


9:15 AM The Patient Protection and Affordable Care Act of 2010, “Maternal, Infant and

Early Childhood Home Visiting Programs: An Overview” Yvette McEachern, Director, Federal-State MCH Partnerships

Center for Maternal and Child Health

9:30 AM Evidence Based Home Visiting Programs: An Overiew Jill Antonishak, Project Manager, Research, Pew Home Visiting Campaign

Pew Center on the States 10:30 AM Break 10:45 AM Preliminary Results, Communities At Risk, Home Visiting Needs Assessment Lee Hurt, Senior MCH Epidemiologist Center for Maternal and Child Health 11:30 AM Participant Feedback by Region and Report Out 12:15 PM LUNCH (provided)

1:00 PM Preliminary Results, Home Visiting Capacity Assessment Mary LaCasse, Chief, State Early Childhood Comprehensive Systems

Center for Maternal and Child Health 1:15 PM Participant Feedback by Region and Report Out 2:00 PM Pulling It All Together

Rena Mohamed, Meeting Facilitator 2:30 PM Next Steps and Closing Remarks Bonnie Birkel and Rosemary King Johnston

Home Visiting Stakeholder Meeting Summary

August 9, 2010

Goals of Stakeholder Meeting

1. Provide stakeholders with an overview of The Patient Protection and Affordable Care Act of

2010, “Maternal, Infant and Early Childhood Home Visiting Programs”

2. Review preliminary home visiting needs assessment data and capacity survey results

3. Engage stakeholders in the development of Maryland’s State Plan

Tasks to accomplish as required by The Patient Protection and Affordable Care Act of 2010, “Maternal, Infant and Early Childhood Home Visiting Programs”:

Complete a state needs assessment that includes: o What are Maryland’s at risk communities? o What is Maryland’s current capacity to provide home visiting services?

Who is currently providing services? How many children and families are currently served by a home visiting

program? What are the current gaps in services What is Maryland’s current ability to meet the needs of eligible families? What substance abuse services are provided to enrolled families

Develop State Plan for implementing home visiting services STAKEHOLDER FEEDBACK Defining Communities at Risk

Participant Feedback Guiding Questions

1. Tell me one thing that was important to you about this presentation. Did you have an “ah‐ha” moment that you would like to share?

2. Are there any additional metrics/indicators (please include rationale as well) that the state should consider in determining communities at risk? (Suggested metrics should be available for every jurisdiction in the state).

3. What are your suggested methodologies for prioritizing communities at risk? 4. Please provide feedback/suggestions if there are indicators that should be weighted more heavily than

others (i.e., do you consider any of the indicators more of a priority than another). Please specify which one and why?

5. Please provide any additional comments or information that you would like the state to consider in defining communities at risk and developing the State’s Home Visiting Plan.

1

2

Table 1& 2: State Agencies I. “Ah‐ha” Moments

Race and ethnic disparities were not addressed

Data looks good but unclear about what the data tells us

Look at MSDE data

How do we meet needs of large groups

II. Additional Metrics/Indicators

WIC usage

Free and reduced meals

Juvenile Justice Data – crime by age, jurisdiction, gender

Mental Health data – maternal depression from MHA by jurisdiction

III. Prioritizing Communities

Subgroup analysis (i.e. infant mortality – age of mother, race, ethnicity, geo code address)

Vital Statistics

CFR information

ADAA – Drug addicted infants

IV. Prioritizing Indicators Infant mortality because it spotlights social problems within a community

Reduce weight of family economic self sufficiency

High School Drop Out rate – is this a good measure of teen pregnancy?

Adjust teen pregnancy age to include teens younger than 15

Include percentage of children enrolled in Medicaid rather than percentage utilizing MA services

V. Additional Comments

Look at available resources available in various communities

Concentration of resources ‐ access vs. usage (i.e. transportation, dentists, obstetricians, etc.)

Cultural competency (i.e. racial disparities)

Title I Schools

How do communities define themselves? Communities should be defined by the individuals who live and work there.

Table 3: Central Maryland – Anne Arundel, Carroll, Harford, Howard

I. Additional Metrics/Indicators

Add School Readiness data – MMSR

Add indicators to capture undocumented population

Adjust adolescent age to 13 – 17

Homeless population not included

Data on substance abusers not in treatment

FARM data

3

Mental health needs of primary caregiver

II. Prioritizing Communities

Decisions should be guided by the best return on investment

III. Additional Comments

Involve consumers in the planning process

Disaggregate data

Need disaggregated data and trends

How is data going to be used for application, to make funding decisions, etc.

Need to weigh the benefits of expanding existing services vs. starting something new

Concern that this region will not get funding because do not look needy based on indicators currently under consideration

Table 4: Lower Shore – Somerset, Wicomico, Worcester I. “Ah‐ha” Moments

Question about the red substance abuse area in Wicomico County


Population density and how it impacts transportation and access to vital services

Title I designated schools or number of children on free and reduced meals

Health Professionals Shortage Area and MUA designated areas

Single parent households

Racial disparity in communities vs. the jurisdictional level

SIT rate – identifies risky behavior (metric doe perinatal outcomes) III. Prioritizing Communities

Maryland PNRA data

Medical Assistance vs. Non‐Medical Assistance as a mechanism for describing the MA population

Maryland perinatal, risk assessment data (some offices)

IV. Prioritizing Indicators Poverty

Racial disparities

Heavily weight the four indicators Maryland selects


Include school readiness data

Look at indicated abuse and neglect rate

Early Care programs – access to programs, parenting skills, school readiness

Table 5: Mid‐Shore – Caroline, Dorchester, Kent, Queen Anne, Talbot I. Additional Metrics/Indicators

MCHIP, Free and reduced lunch, WIC to look at poverty

Maryland Adolescent Survey administered by MSDE – self report of substance abuse for teens

4

Teens under 15 giving birth

Health Professionals Shortage Area designation (HRSA)

Census data does not capture undocumented population

Prenatal Risk Assessment (Infants)

Youth Risk Behavior Survey to assess indicators of risk behavior

Literacy rates

II. Prioritizing Communities

Define community – this could be different for rural, suburban, and urban jurisdictions

Collaborative system of care applications

Table 6: Baltimore City and Baltimore County I. Additional Metrics/Indicators

WIC participation

Free and reduced lunches

Vacant or subsidized housing – lack of affordable housing

Homeless management system

Juvenile crime (serious crime) by gender

Children entering school ready to learn – Work Sampling System, Infant and Toddler referrals

Out of home placements

Maternal smoking (birth records)

Inter‐pregnancy intervals

II. Prioritizing Communities Look at trends over the 10 year period – are there jurisdictions that are trending down?

Table 7: Prince George’s & Southern Maryland – Calvert, Charles

I. “Ah‐ha” Moments

Comforted regarding openness to different home visiting programs

Concerned about use of old census data (2000) in light of changes, growth in communities in the last decade

What about pockets of poverty in rural communities using current methods (i.e. large census tracts)

Accessibility and lack of services (gaps) issues do not seem to be reflected in map

What about using injuries for child abuse data reporting rather than deaths?


WIC data

Income maintenance data

Drug affected new born data (substance abuse measure)

III. Prioritizing Communities

Take into account multiple risk factors

5

Can population be targeted as opposed to geographical area? Could communities be defined this way?

IV. Prioritizing Indicators Based on data and experiences of practitioners:

Infant mortality

Domestic violence

Access to prenatal care


Spread the wealth

In order to retain staff plan for yearly increases to support staffing

Look at expanding/supporting existing programs – taking special care to improve programs to reach outcomes

Table 8: Montgomery & Frederick Counties I. “Ah‐ha” Moments

Using old data – huge shifts in data

Multicultural issues not reflected

Using Medical Assistance data excludes people – run into access issues

Breath of data and then index – FARMS data


MCHIP

Juvenile crime rate

Percent of families per jurisdiction

Percent of poverty level per jurisdiction

Immigrant population

DJS/State police – Gang Net data

III. Prioritizing Communities • Percent of population that are

o families o under 8 years old

• Multicultural families • Foreign born families • Multilingual families

Seat belts in cars

IV. Prioritizing Indicators Poverty

Maternal education

School Readiness – single identifier, infant and toddlers

Race/ethnicity

Immigrant rate

Missing teen rate (under 15 years of age)

Multicultural demographics


What about the stories – need qualitative and anecdotal data

Do we just to focus on the negative data? Positive data reflects where things are working well.

Table 9: Western Maryland – Allegany, Garrett, Washington I. “Ah‐ha” Moments

$1,000,000 does not go far across the state


Assess where we are doing well – resources, what’s at risk, stability/sustainability in the future

Where are EBPs based across the State/region? How does their data look?

Access to services – medically underserved areas

Include child poverty

Educational attainment Capacity Assessment

Participant Feedback Guiding Questions

1. Tell me one thing that was important to you about this presentation. Did you have an “ah‐ha” moment that you would like to share?

2. Are there other home visiting programs within your region/community that we should contact for inclusion in the capacity assessment?

3. In addition to the survey, please identify other suggested methods for assessing home visiting capacity in Maryland.

4. Please provide any additional comments or information that you would like the state to consider in defining capacity and developing the State’s Home Visiting Plan.

Table 1& 2: State Agencies

I. “Ah‐ha” Moments How is a unit of service defined? Ask jurisdictions how they define a unit of service.

Healthy Families and Home Visiting Consortium have each defined service.

Develop overall definitions for home visiting – definitions need to move the work forward

Programs have variable methods of referrals – how are families identified and referred?

Do all programs have an outreach component? How is outreach defined?

Establish common data elements ‐ face to face contact in the home for a specified amount of time

Do programs do prevention work?

6

7

II. Other Home Visiting Programs

Given the timeframe we should focus on who is currently involved. Others can be included along the way

Conduct key informant interviews

Share survey with providers and families served

Review evaluations that have been done for each program. Can they be used in further assessments

III. Other Methods for assessing capacity

Contact local or state agencies to cross reference information

Should identify target population and include representative in planning process

Identify if programs have a wait list, if so how long and do they receive some services while on the wait list

Identify length of service for programs

Identify who is receiving the service (mom only, baby only, legal guardian, mom and baby, mom, baby and dad). Define family.

Identify local community leaders/organizations to facilitate focus groups and identify key informants (faith community, coalitions, Judy Centers etc.)

IV. Additional Comments

Clear list of existing programs – funding amount, sources of funding, who they serve, funded capacity, contact information, education level of staff, staffing pattern

Table 3: Central Maryland – Anne Arundel, Carroll, Harford, Howard


Survey was very program specific and not generalized to capture the need of the community

Population served was not discussed (i.e. parents with cognitive impairments). How do programs adapt service delivery to meet the needs of different populations

Are intergenerational needs addressed through service delivery?

Review length of survey and some folks had difficulty completing

II. Other Methods for assessing capacity

Develop a shorter more generalized survey to send out to a broader audience

Include input from consumer and other agencies (i.e. DSS, DJS, DDA)


Desire to have had this meeting earlier in the planning process. Will the information gathered be utilized as the process moves forward?

Need to develop and consider criteria for readiness to expand services

Hold focus groups with atypical populations

With the limited funding available may not be able to only consider high need and low capacity because capacity building takes time and the funding may not be available to support

If considering existing program capacity need to also consider results and impact

8

Identify community readiness to expand existing services

Table 4: Lower Shore – Somerset, Wicomico, Worcester I. “Ah‐ha” Moments

Concerns about some survey responses – high volume reported may be due to multiple agencies reporting duplicated count

Some respondents may have been unclear when responding to questions

Concern about focusing on areas with high need/low capacity to determine priorities II. Other Home Visiting Programs

Missing some possible home visitors

See continuum ‐ gaps in ages, focus


Collaborative case coordination as an asset (i.e. Multi‐D)

Additional funding may be needed for new/existing information sharing

Need to establish strategy for assessing organizational capacity particularly for new organizations

Table 5: Mid‐Shore – Caroline, Dorchester, Kent, Queen Anne, Talbot


Lack of funding decreases capacity

Need to identify what programs are in each region, who they are serving, and their capacity

Could not complete the survey if you were not operating a home visiting program


Determine if there are home visiting programs in schools that serve children 6 – 8 years old

Link to local Infants and Toddlers programs

Reach out to DSS Family Preservation programs, Child and Behavioral Health programs, Project Right Steps


Capacity assessment should include required staffing pattern and identified population as identified by the model being implemented

Look at capacity to implement, evaluate, and sustain program

Assess cost effectiveness of program to include the fact that implementing prevention strategies decreases the need for intervention later.

Capacity should also cost out service hours provided (i.e. travel, services, administrative/paperwork, number of attempts to reach family)


Time needs to allotted for implementation

Is there language in the funding language that prohibits serving undocumented families?

9

Table 6: Baltimore City and Baltimore County I. Other Home Visiting Programs

Contact funding agencies or national associations

Utilize local health departments or local management boards

Distribution of Family Support Network and Health Start Network around state

II. Other Methods for assessing capacity

Identify current capacity (i.e. low, high); what percentage of need is met

What models are available to meet need/capacity?

Triage need – develop an array of services to meet various levels of need


Gain understanding of duplication/overlap of services

Table 7: Prince George’s & Southern Maryland – Calvert, Charles I. “Ah‐ha” Moments

Thought there was more federal funding available

Some questions regarding survey design – who was supposed to complete, duplication of responses


Judy Centers

Early Head Start

Parents as Teachers

MCH

HIPPY


How do we capture undocumented families?

How do we capture families who deliver out of county (i.e. high risk pregnancy delivering in DC or Baltimore)?

Include consumers in surveying

Need interpreters/bilingual staff to assist with service delivery and to assist with ensuring non English speaking families have the opportunity to contribute


State plan needs to allow for flexibility to implement innovative and promising practices

Funding allocations need to have lower administrative costs so more dollars can be allocated for direct services

Sustain program infrastructure over the duration of funding (i.e. technical assistance, training, evaluation)

Build in funding increases from year to year to support staff retention

Expand existing programs that have demonstrated successful outcomes

10

Table 8: Montgomery & Frederick Counties I. “Ah‐ha” Moments

Define models vs. curriculums (i.e. Healthy Families vs. Parents as Teachers)

Survey should have questions to identify gaps in services

Definitions needed for the survey to ensure consistent responses; some questions might have been subject to different interpretations

Include definition of annual evaluation

What agencies/programs were targeted for completing the survey?


How is home visiting defined?

How is partnership defined? Service provided by Agency A may not be feasible without Agency B

Has Infants and Toddlers been considered?


Complete a time study to compare programs and capacity

Define home visiting

Ensure that there is not duplication in responses


Ensure that training costs are included in budget

Account for model intensity – step down models, match model with family need

Is the program’s service capacity able to meet the need of the eligible population

Table 9: Western Maryland – Allegany, Garrett, Washington I. “Ah‐ha” Moments

There was some confusion on some of the survey questions (i.e. how many families were served in your whole program or just on your home visiting program?)


DSS Family Preservation programs

Identify programs being implemented but may not have sustainable funding


Concerned about obtaining outcomes if focus on areas with high need and low capacity


Staff retention rates and training is a concern

11

Emerging Themes: 1. Discuss the possibility of accessing more recent data for needs assessment

a. Race/ethnicity b. School readiness c. Undocumented population d. WIC utilization e. Medicaid eligible families

2. Develop a mechanism for gathering consumer input 3. Develop standard definitions for capacity survey 4. Develop a state plan that is inclusive of

a. home visiting programs that are effective with families with various levels of need (i.e. a home visiting system on care)

b. support, funding, and time needed to develop and implement a sustainable program

Maryland Home Visiting Stakeholder Meeting Rice Auditorium, Spring Grove Hospital Campus

August 9, 2010 EVALUATION RESULTS


1. The content of the meeting was useful to help Maryland move forward with the needs assessment.

Responses: Strongly Agree – 2 1) – 11 2) – 23 3) – 16 4) – 5 5) – 1 Strongly Disagree – 1 Comments:

- Thank you for including everyone - The requirement of the meeting was well met - Request for data from School Readiness and Title V/ FARMS - Decisions seemed to already be made prior to meeting *There seems to have been some confusion with the survey numbering/ responses.

2. The meeting met my expectations.

Responses: Strongly Agree – 1 1) – 9 2) – 22 3) – 18 4) – 7 5) – 2 Strongly Disagree – 1 Comments:

- There was a lack of regard for local input – 2 - Thank you for taking the time to listen - The meeting was held after the fact - Not clear on home visit program

3. The meeting facilitated collaboration and networking on home visiting issues.

Responses:

Strongly Agree – 2 1) – 10 2) – 25 3) – 13 4) – 7 5) – 2 Strongly Disagree – 1 Comments:

- The focus was only on the needs assessment. There as no idea or resource sharing - GREAT networking opportunity

4. The round table discussion on DATA as relevant and helpful.

Responses: Strongly Agree – 2 1) – 12 2) – 20 3) – 18 4) – 5 5) – 1 Strongly Disagree - 0 Comments:

- It was too late to change the focus of data collection, decisions already made - We need to collect updated/ new data - The round table needed more participants

5. The round table discussion on CAPACITY was relevant and helpful.

Responses: Strongly Agree – 2 1) – 11 2) –17 3) – 21 4) – 8 5) – 1 Strongly Disagree – 0

Comments:

- The round table needed more participants

Please rate the meeting location: Responses: Excellent – 9 Good – 25 Adequate – 19 3.5) – 1 Marginal – 2 Poor – 1 Comments:

- The directional signs were helpful - The chairs were very uncomfortable - The meeting needed better directions - Free parking is always good - The food was excellent – 4 - Since the focus was by region, it would be nice to see future meetings on Lower Eastern Shore, for

Worcester, Wicomico, and Somerset Counties - It was a long drive for those from the shore – maybe a later start time? - The acoustics were terrible – 2 - Space was good

Additional Comments:

- There were too many housekeeping issues - Very informative meeting. It as very productive to get so many individuals into one room. - The notice for the meeting seemed to have come out at the last minute. There was no time to share

the notice with other partners that should have been there - Please continue to send information regarding this topic, this “meeting does not stop here.” - The meeting was promptly executed - There was an opportunity to have input - “State staff need to make sure their comments (and sometimes laughter) at what was offered are

not observed. It could make the effort seem in-genuine.” - Need to look at rural areas separately from the urban areas - There was a lot of useful information on the status of the Needs Assessment to take back to the

local counties. - Unfortunately the theme at our table was the decision for money has already been determined. - “The event is a Catch 22: Not enough definition and guidance from the federal level in order to be

truly purposeful, but without a stakeholder meeting or focus groups, programs would have felt slighted and left out of planning and decision making.”

Home Visiting Stakeholders Responses

County

Name

E-mail

HFM

LMB

PAT

LHD

EHS

HIPPY

Other/ name

ALL Melissa Crowe [email protected] X Carole Kenny [email protected] X Rebecca Krampf [email protected] X AA Pamela M. Brown [email protected] X

BCO Toya Singletary [email protected] DSS Elise Andrews [email protected] X Tomaka Jupiter [email protected] Dir. Program Dev./Abilities

Network Linda Grossman, MD [email protected] X Bureau Chief, Clinical Services Margie Koretzky [email protected] X Youth, Family Services Deanna Cavagna [email protected] BC Public Scho ols CAL Theresa Booker [email protected] X CARO Renee Woodworth [email protected] Human Services Council, Inc. Leland Spencer [email protected] X HO – Kent/Caroline* Jennie Holmes [email protected] X Terri Miller (none given) X Designee for Teresa French CARR Mary Scholz [email protected] X Penny Bramlet [email protected] X

1

County

Name

E-mail

HFM

LMB

PAT

LHD

EHS

HIPPY

Other/ name

C EC CHAR Catherine Meyers [email protected] X Exec.Dir. – Center for Children,

Inc. D. Mia Gray [email protected] X Early Childhood Coordinator DOR Beth Nossick [email protected] X FRED Shannon Aleshire [email protected] MHA of Frederick, MD. Donna Devilbiss [email protected] X GAR Earleen Beckman [email protected] X Crystal Stewart [email protected] X Lucia Barger [email protected] X HAR Elizabeth Hendrix [email protected] Deputy Director, Dept. of

Community Services Melinda Kreisel [email protected] X Div. of Care Coordination HOW Keri Hyde [email protected] Office of Children’s Services Brenda Radtka [email protected] X Lisette Osborne [email protected] X For HO Beilenson

2

County

Name

E-mail

HFM

LMB

PAT

LHD

EHS

HIPPY

Other/ name

KENT Rebecca Lepter [email protected] X Leland Spencer [email protected] X HO – Kent/Caroline* Karen Hill [email protected] X In-home Interventionist MONT Monica Ortiz [email protected] Family Services, Inc. Janet Curran [email protected] X Carol Walsh [email protected] Collab. Council for CYF, Inc. Debbie Shepard [email protected] Dept of H HS Shari Waddy [email protected] MHA/Families Foremost Isabel Cassen [email protected] Dept of HHS/PHS/CHS Helma Irving [email protected] Family Services, Iinc. PG Judy M. DuBose [email protected] X PG’s Child Resource Center Marti Worshtil [email protected] Lillian Janssen-Checa [email protected] X Rosa Bowers [email protected] Adelphi Langley Park, Famiy

Support Center QA Mary Ann Gleason [email protected] Community Partnerships for

Children & Families St .M SOM Lori Conklin [email protected] X Dir. Of Community Health Susanna Henson [email protected] X Exec. Director Dawn Rea Scher [email protected] X

3

County

Name

E-mail

HFM

LMB

PAT

LHD

EHS

HIPPY

Other/ name

TAL Thomas McCarty [email protected] X Deputy HO Gloria Dill [email protected] X CHN WASH Susan Parks [email protected] X Melissa McElroy [email protected] X Tracy Soffe [email protected] X X Healthy Families/WCHD WIC Micaela Tedford [email protected] Partnership for Families & Children

Carrie Connelly [email protected] X Rose Johnson [email protected] X X WOR Rebecca Brunet [email protected] X Andrea Mathias [email protected] X BC Alma Roberts [email protected] CEO – Balt.City Healthy Start Jean Mitchell [email protected] Director – Maryland Family

Network, Inc. Nancy Corcoran [email protected] X MD Family Network Avril Melissa Houston [email protected] X Assn’t Commissioner, MCH Rebecca Dineen [email protected] X Bureau Chief, Mat. & Infant Univ of MD

Kay Conners [email protected] Program Direc tor

MSDE Barb Scherr [email protected] Family Involvement Coordinator Linda Zang [email protected] Branch Chief, Collaboration

and Program Improvement Linda Heisner [email protected] X Healthy Families Programs DHMH Rosemary Murphey [email protected] Nurse Consultant - Medicaid Lee Hurt [email protected] MCH Epidemiologist Pam Putman [email protected] Chief, MCH Systems Improv.

4


5

County

Name

E-mail

HFM

LMB

PAT

LHD

EHS

HIPPY

Other/ name

Russ Moy [email protected] Director, F HA Mary LaCasse [email protected] Yvette McEachern [email protected] Bonnie Birkel [email protected] Diedre McDaniel [email protected] Rachel Hess-Mutinda [email protected] Christine Evans [email protected] .us S. Lee Woods, MD [email protected] DHMH/MHA

Joyce C. Pollard [email protected] Early Childhood MH

DHMH/ADAA

Suzette Tucker [email protected] Regional Serv. Manager/ Women’s Coordinator

DBM Allan Pack [email protected] Budget Analyst

GOC Rosemary King Johnston [email protected] Executive Director Kim Malat [email protected] Chief, Grant/Contracts Admin. DJS Jennifer Maehr [email protected] Medical Director MFN Margaret Williams [email protected] Exec.Dir. MD Family Network


Brooklyn

South

Southeastern

Guilford

Cedonia

Irvington

Violetville

Echodale

Highlandtown

Edison

Falstaff

Hampden

Claremont

Westport

Lauraville

Hamilton

Howard Park

Northwood

Roland Park

Beechfield

Pimlico

Rosemont

Walbrook

Loch RavenMt. Washington

Clifton

Penn North

Southwest

Cherry Hill

Cheswolde

Dickeyville

Canton

Dorchester

Midtown

Govans

Mondawmin

Federal Hill

Upton

Oldtown

Sandtown

Midway

Washington Village

Waverlies

Downtown

Perkins

Greenmount

Madison

Park Heights

Belvedere

Charles Village

Fells Point

Edmonson Village

Patterson Park

Highlandtown

Hollins Market

Number of Elevated Indicators by CSA (Neighborhood), Baltimore City, Maryland

Legend

# of Elevated Indicators(Maximum=15)

1- 3

4 - 6

7 - 9

10 - 12

13 - 14

Prepared by MD DHMH, Center for Maternal and Child Health

Appendix H.

MARYLAND FY 2009

Development, Operation & Expansion of Community-based &

Prevention-focused Programs

Services Provided to Families by Local Programs

Unmet Needs Identified by the Inventory

Maryland Family Network, as the lead agency continued to work with funders, partners, and stakeholders to improve the system of child abuse and neglect prevention and the delivery of family support services in Maryland. Partners included the Early Childhood Mental Health Steering Committee, Child Care Advisory Council, the Maryland State Department of Education’s Judith P. Hoyer Early Child Care and Education Enhancement Advisory Council, State Superintendent’s Family Involvement Council, Baltimore Babies Born Healthy Leadership in Action Program, and Maryland’s Home Visiting Consortium.

Maryland’s family support network consists of two parts: the statewide lead intermediary agency, Maryland Family Network; and 24 community-based initiatives, each led by a public or private non-profit agency that partners with others in the community to provide prevention-oriented, family resource and support services. The network’s core funding comes from state and federal sources, including the Community-Based Child Abuse and Prevention grant, administered under contract by Maryland Family Network.

Local family support programs in Maryland delivered prevention-oriented, community-based, voluntary services that support parents and their children, primarily infants and toddlers. Twenty-three programs located in 16 out of the State's 24 jurisdictions (Baltimore City and 23 counties) operated during the fiscal year. The State and Maryland Family Network continued to target family support dollars to areas with high concentrations of pregnant and parenting adolescents, children living at or below the poverty level, births of low birth-weight babies, adults who have not completed high school, and unemployed adolescents and adults.

Respite services were available at every local family support program in the network (23 locations) to any primary caregiver with a young child who visits a local family support program. Local family support initiatives funded with CBCAP dollars in Maryland are expected not only to offer developmentally appropriate care to very young children at least 35 hours per week, but also to support children’s parents, directly or through linkages to other community-based providers – with skilled counseling, peer support, and other services (whatever the parent needs) – while the children are on site.

Home visiting within the network’s family support programs supports high-risk parents of children from birth through age three in their role as parents by improving the quality of parent, child, and family interactions. CBCAP funds are used to augment home visiting services throughout the network. Home visiting program objectives are: to engage “hard to reach” families by offering them

home-based services;

There continues to be a large, unmet need for programs specifically designed to provide stable fatherhood services that will help to reduce the risk of children being abused, neglected, or removed from their natural homes. Maryland Family Network continued to support local programs to insure that retention and recruitment efforts are successful in involving fathers and significant men in children’s lives, and that center-and home-based services meet the needs of fathers in a welcoming, supportive, responsive environment. MFN supported local programs by funding small local grants to support fatherhood/family activities.

to recruit parents to participate actively in center-based services; and

to engage parents in community services.

Description of Number of Families Served

Outreach to Special Populations

Parent Leadership

During this reporting period, programs receiving CBCAP funding through the lead agency provided direct services to: 6,913 individuals; 2,643 families; 2,271 children birth through three years;

and 112 children with developmental

disabilities.

In addition, the lead agency provided training services to 400 staff and parents.

Maryland Family Network has ensured that all programs target their services to young parents of very young children, as they are most vulnerable to the negative consequences of early childbearing, especially long-term poverty.

Several local programs provided services at homeless shelters and transitional housing sites including on-site parenting classes, parent/child activities, and other support services.

Many programs in areas with migrant workers and citizens not born in this country have hired staff that can speak compatible languages and provided services at locations outside their normal bases of operation in order to meet the needs.

A substantial number of participants in local programs were identified as having learning disabilities. Adults with other mild and moderate disabilities are a target population of the network, and the lead agency worked with various public and private non-profit groups in the State for reaching out to and serving this group.

Local CBCAP funded programs served as “natural environments” for treatment programs designed as part of the Intensive Family Service Plans for Part C/IDEA.

Parent support and involvement activities are designed to develop a wide range of participant skills, strengths, and interests. Activities include providing advisory and volunteer opportunities at the programs, and recreational and social activities. Empowering young families requires holistic programming––not only educational and parenting sessions. but also opportunities to develop the wide range of skills, strengths, and interests of participants. Recreational programs are therapeutic in the sense that they are vehicles for creative expression, group linkages, challenges, and achievements. Often other family members and community are included.

Building on previous success with Parent

Leadership training, Maryland Family Network secured funding through Mid Atlantic Equity and continued its partnership with the development of the Parent Involvement and Resource Center project (PIRC). Parent leadership training was provided to mothers, fathers, and primary caregivers of children birth through five years who participated in Judy Hoyer Partnerships, Early Head Start, and Family Support Centers.

Promoted by the Parent Leadership Institutes, parent involvement at the State level occurs with the Early Head Start Policy Council and a parent member who serves on the Board of Directors of Maryland Family Network. Parent involvement at the local level is encouraged in all areas of program activity. Community-based partners in Maryland’s family support network are required to have regular participant

meetings co-facilitated by parents. Training and Technical Assistance Child Abuse Prevention Month Activities Innovative Funding Mechanisms

Members of the network share a common

approach to practice, participate in joint training, receive technical assistance from or through Maryland Family Network, and report on operations using a common Management Information System (MIS).

CBCAP funding was provided to the Maryland Respite Care Coalition to sponsor and underwrite costs for the 11th Annual Maryland Respite Awareness Day Conference held in October 2008. MFN awarded CBCAP funds to Caring Communities, a private, nonprofit organization that provides pediatric respite care services for families, and co-sponsored the World of Possibilities Disabilities Expo 2009 in Maryland.

Parent Leadership training was conducted by two MFN Program Consultants with expertise in operating complex community-based programs through direct service providers. Two days of skill-building training and practice in essential communication skills, decision-making, and advocacy was offered to 60 parents at three locations.

After completing the two-day Parent Leadership training, PIRC participants were invited to attend a special parent leadership track at the Annual Spring Training and Staff Development Conference held in May 2009. Parents from Family Support Network programs were also invited to attend the two days of leadership training, which included discussions on leadership, advocacy, influence and power; and skill building

State and private organizations, such as The Family Tree and People Against Child Abuse (the Maryland Chapter of Prevent Child Abuse), and the Maryland CASA Association (Court Appointed Special Advocates) provided public awareness activities to increase the visibility of prevention during April 2009. Maryland Family Network and the network of local family support initiatives worked with these agencies and many other organizations at both state and local levels to support these activities whenever needed and throughout the year. Community Resource Packets were distributed in family support communities throughout the State. MFN partnered with organizations in Harford County, Maryland to offer a symposium during Child Abuse Prevention Month to enhance skills and increase knowledge of professionals and others in the field. The main focus of the symposium was to address investigative, judicial and treatment issues regarding child victims of abuse and their families.

During this funding period, the lead agency and network programs leveraged $2.93 for every $1 invested by the State of Maryland. According to audited financial statements, approximately 4% of the total amount has gone to administrative and fund raising expenses; the rest has gone directly to community-based services.

Maryland Family Network secured the following funding during the fiscal year: A three- year grant award for continued

grants management, technical assistance, training, and quality assurance monitoring services for the network from the Maryland State Department of Education.

Secured private foundation and corporate funding to support family literacy and early learning activities in the family support network. MFN provided thousands of new books for children ages 0-3 years through Reading Is Fundamental.

Maryland State Department of Education awarded funding to coordinate the State’s Home Visiting Consortium (HVC); MFN convenes and co-facilitates meetings and training opportunities for the HVC membership for the purpose of quality assurance, professional development, and networking.

Funding was awarded by the Mid-Atlantic Equity Center to support training and implementation of a parent education curriculum “The Nurturing Program” for participating families at family support programs.

related to listening and communication and public speaking skills.

Maryland Family Network provided a variety of staff development opportunities to the Maryland Family Support Network. Training was provided to nearly 400 network staff, and approximately 100 staff development sessions were offered with the goal of heightening awareness, building skills, and empowering staff.

Two major conferences, two week-long orientation programs, two three- day child development staff training programs and additional staff training sessions were held for Family Support Network staff over the course of the funding year. These network-wide staff development activities provided over 60 structured learning opportunities over the course of the year.

State supplemental funds were awarded to provide child development program enhancements at Early Head Start programs within the network.

MFN received funding from Bank of America to improve the MFN website.

Secured ARRA funding to improve the Health and Safety environments of Early Head Start programs operating within MD Family Network.

Linkages with Other Systems (Child Welfare, PSSF, Early

Childhood, etc.)

A. PART Data Efficiency Measure that Supports EBP and EIP Practices

B. Demonstration of High Level of Satisfaction Among Families

The Birth through Three Business Plan for Maryland developed by Maryland Family Network in partnership with the Maryland State Department of Education, and with stakeholders representing state agencies, local government agencies, private service providers, corporate leaders, research institutions, and parents was completed during the past year. Work progress this reporting period included printing the plan and networking with public and private agencies around the State to promote it.

Maryland Family Network staff serves on the Child and Family Services Planning Committee (CFSPAC), the statewide advisory

Nineteen CBCAP funded programs use promising programs and practices.

The fulfillment of the parent involvement requirement is monitored as part of the network’s On-Site Monitoring Process. Maryland Family Network’s Program Monitor interviews program participants during the on-site visits to get a sense of their involvement with satisfaction with Center programming and services.

The family support network in Maryland is designed to be customer-driven. The theory is that parents vote with their feet: if programs are good, they will be well used. If participation is spotty and retention poor, the programs are changed or closed. Participation rates and other process data are used as important indicators of

group responsible for reviewing the State’s IV-B Child and Family Services Plan which outlines Maryland’s mission and vision and plans to meet goals and objectives to promote and ensure safety, permanence, and well-being for children and families. Maryland has incorporated priorities of the Program Improvement Plan (PIP) into its CFSP. The Committee assists this initiative in the following ways: 1) identify challenges facing Maryland’s child welfare system; 2) provide information and experience from various perspectives; and 3) identify potential collaborative strategies to meet the challenges.

Maryland Family Network worked collaboratively and actively with the State Department of Health and Mental Hygiene Center for Maternal and Child Health in support of its application as the State Title V Agency for continuation of the State Early Childhood Comprehensive Systems (ECCS) program.

parent satisfaction and are regularly collected, analyzed, and disseminated to and for all local programs. Maryland Family Network generates Monthly Participation Summaries from the MIS for all local programs.

In partnership with the Mid Atlantic Equity and US Department of Education, the lead agency secured funding to address the changing needs of participating parents through the provision of parent education and implementation of the Nurturing Program. Maryland Family Network conducted a parent/caregiver evaluation in order to ensure the quality and usefulness of program services and activities. Parents completed the survey ranking their level of satisfaction with program services and reporting their knowledge, skills, practices, and responsibility in essential communication, decision-making, advocacy, and parenting. Parents self-report family demographics and provide opinions, experiences, and suggestions for program improvements.

C. Results of Peer Review D. Evaluation Data on Funded Programs, the Lead Agency & the Network

Other Elements:

In honoring the commitment to accountability and quality assurance, Maryland Family Network involves peers wherever possible and includes other parties impacted by the practice or policy being reviewed.

The fifth formal Peer Sharing Process involved team members (from the same Center, and teams were comprised of the Director), the Child Development Specialist and the Services Coordinator/Family Services Advocate. Peer Review teams were not allowed to visit a program in the same or adjacent district. Directors used a master

Maryland Family Network continues to maintain a database that tracks the status of completion of required training for all network staff employed at Family Support and Early Head Start programs. The database includes a variety of professional information about each staff person including: date of hire, highest level of education, field in which education was obtained, any additional certification (PAT, 90 Hours, CDA), and years of experience in the field. The database tracks staff completion of required training for their specific position: all staff who work 30+ hours per week are required to complete the Family Support Network Orientation within six months of hire, all child development staff working 30+ hours per week are required to complete Early

Maryland Family Network continued to focus on working with State and local partners to implement recommendations of the Maryland’s comprehensive plan to ensure that infants and toddlers, ages 0-3, receive a strong foundation for learning.

Maryland Family Network continued to serve on the State’s Child and Family Services Planning Committee (CFSPAC) established to develop, review, and provide input to the State’s Child and Family Services Plan (CFSP). The Advisory Committee meets quarterly and focuses efforts to determine how best to support Child Welfare

calendar to schedule their own teams for visits as well as for scheduling the Review Team to visit their own program. Program Directors (designated team leaders) complete a report of the visit based upon the Peer Sharing Tool, and present a copy to the Center visited. A signed copy is forwarded to their Program Consultant at MFN. Directors reported that the time spent with their own management team traveling together and visiting another program and then discussing the visit, planning, strategizing and gathering new ideas, was very productive.

Childhood Best Practices within six months of hire, and other training requirements are to be completed within the first year of hire. Most required training is completed by participation in MFN-sponsored training.

Maryland Family Network evaluated the performance of the network’s family support programs by using the qualitative information gathered during scheduled and impromptu visits to the Centers and by quantitative information provided by the participant database or Management Information System (MIS). The MFN MIS system provides information about Center participants and their utilization of Centers, and these data are used to monitor services provided by the programs and compare results with contract requirements and program performance goals––standards based on numbers and types of participants, types of service provided, and intensity of service utilization. Data are recorded on a daily basis to document services, progress toward outcomes and changes in a participant’s status, collected quarterly, and used to provide case management services and to document outcome measures for the network and for individual Center use.

Outcomes and to develop and implement strategies for collaboration to achieve Child Welfare Outcomes.

Maryland’s Family Support Centers BALTIMORE CITY Bon Secours Family Support Center 26 N. Fulton Avenue Baltimore, MD 21223 tel 410.362.3629 fax 410.362.3649 Director Lori Fagan Sponsor Bon Secours Baltimore Health System, Inc. Our House 2707 Sethlow Road Baltimore, MD 21225 tel 410.396.8469 fax 410.545.0195 Director Cassandra DeLeon Sponsor HABC/Division of Family Support Services Park Heights Family Support Center 4330-D Pimlico Road Baltimore, MD 21215 tel 410.578.0244 fax 410.367.1927 Director Linda Harvey Sponsor Family & Children's Services of Central MD Southeast Baltimore Early Head Start Center 2811 Dillon Street Baltimore, MD 21224 tel 443.923.4300 fax 410.563.2725 Director Gayne Barlow-Kemper Sponsor Kennedy Krieger Family Center Waverly Family Support Center 829 Montpelier Street Baltimore, MD 21218 tel 410.235.0555 fax 410.366.7720 Director Sharon Thomas Sponsor Goodwill Industries of the Chesapeake, Inc. ALLEGANY COUNTY Cumberland Family Support Center 205 Baltimore Avenue Cumberland, MD 21502 tel 301.724.5445 fax 301.724.0642 Director Janice Cannon Sponsor Cumberland YMCA ANNE ARUNDEL COUNTY Annapolis Family Support Center 80 West Street Annapolis, MD 21401 tel 410.269.4478 fax 410.974.2139 Director Stacey King Sponsor Anne Arundel Co. Dept. of Social Services Anne Arundel Early Head Start 6243 Shady Side Road P.O. Box 158 Shady Side, MD 20764

tel 410.867.8945 fax 410.867.8947 Director Carmelia Hicks Sponsor AA Co. Economic Opportunity Committee BALTIMORE COUNTY Young Parent Support Center 201 Back River Neck Road Baltimore, MD 21221 tel 410.853.3860 fax 410.686.5479 Director Kevin McShane Sponsor Baltimore Co. Dept. of Social Services CAROLINE COUNTY Caroline County Family Support Center 100 N. 6th Street Denton, MD 21629 tel 410.479.3298 fax 410.479.3789 Director Tearesa French Sponsor Caroline County Board of Education Federalsburg Judy Hoyer/EHS Center 323 S. University Avenue Federalsburg, MD 21632 tel 410.754.2467 fax 410.754.7091 Director Tearesa French Sponsor Caroline County Board of Education CARROLL COUNTY Carroll County Family Support Center 10 Distillery Drive P.O. Box 489 Westminster, MD 21158 tel 410.876.7805 fax 410.386.6675 Director Joyce Tierney Sponsor Human Services Program of Carroll County CECIL COUNTY Family Education Center 200 Road B Hollingsworth Manor Elkton, MD 21921-6623 tel 410.287.1100 fax 410.392.9548 Director Barbara Istvan Sponsor Cecil College DORCHESTER COUNTY Dorchester County Early Head Start Center 824 Fairmount Ave. PO Box 215 Cambridge, MD 21613 tel 410.901.2015 fax 410.901.2057 Director Sponsor SHORE UP!, Inc. FREDERICK COUNTY Family Partnership 8420 Gas House Pike Suite EE Frederick, MD 21701 tel 301.600.2206 fax 301.600.2209 Director Shelly Toms Sponsor Frederick Co. Office for Children & Families

Up-County Family Support Center 303 W. Lincoln Avenue P.O. Box 158 Emmitsburg, MD 21727 tel 301.600.7450 fax 301.447.6325 Director Michelle Gallipoli Sponsor Frederick Co. Office for Children & Families KENT COUNTY Kent Family Center 601 High Street Chestertown, MD 21620 tel 410.778.7911 fax 410.778.6328 Director Marianne Peltier-Allison Sponsor Shared Opportunity Service, Inc. MONTGOMERY COUNTY Families Foremost Support Center 1109 Spring Street, Suite 300 Silver Spring, MD 20910 tel 301.585.3424 fax 301.585.8382 Director Shari Waddy Sponsor Mental Health Association PRINCE GEORGE’S COUNTY Adelphi/Langley Park Family Support Center 8908 Riggs Road Adelphi, MD 20783 tel 301.431.6210 fax 301.431.6212 Director Danitza Simpson Sponsor Prince George’s Child Care Resource Center QUEEN ANNE’S COUNTY Family Support of Queen Anne's County 103 N. Linden Street PO Box 201 Sudlersville, MD 21668 tel 410.438.3182 fax 410.438.3806 Director Dorothy Carpenter Sponsor Queen Anne's Co. Board of Education TALBOT COUNTY Talbot County Family Support Center 215 Bay Street, Suite 1 Easton, MD 21601 tel 410.820.6940 fax 410.820.6958 Director Stella Lee Coulbourne Sponsor Talbot County Health Department WASHINGTON COUNTY Washington County Family Support Center 920 W. Washington Street, Suite 100 Hagerstown, MD 21740 tel 301.790.4002 fax 301.790.4007 Director Dori Yorks Sponsor Washington Co. Dept. of Social Services WICOMICO COUNTY

Wicomico Family Support Center SHORE UP! Inc. 500 Snow Hill Road PO Box 430 Salisbury, MD 21804 tel 410.860.9194 fax 410.860.9373 Director Sheree Sample-Hughes Sponsor SHORE UP!, Inc. Revised 8.9.10

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Maryland’s Statewide Needs Assessment · 20/09/2010 · community forums and focus groups of key...

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